Uninsured Children Transferred After ED Visits More Than Privately Insured Children

New data presented at the AAP 2016 National Conference and Exhibition showed that transfers from the emergency department (ED) to another facility occur more frequently among pediatric patients without insurance or with Medicaid, when compared to patients with private insurance.

“Our findings suggest a systematic bias toward admitting children with private medical insurance and transferring those without insurance or with Medicaid,”  Yunru Huang, a PhD candidate at the University of California, Davis, told First Report Managed Care. “Those findings reinforce ongoing concerns about disparities in the provision of pediatric ED and inpatient care, and also call into question the three-decade-old Emergency Medical Treatment and Active Labor Act requiring hospitals to make decisions on patients’ transfer or admission independent of their insurance status.

The researchers assessed the implications of ED transfer trends among pediatric patients and how these trends relate to Emergency Medical Treatment and Active Labor Act. The law is in place to ensure that hospitals only base transfer decisions on clinical factors or the need for specialty medical services. 

Dr Huang and colleagues studied data from the Healthcare Cost and Utilization Project 2012 Nationwide Emergency Department Sample. They narrowed down study participants to 240,620 pediatric ED visits at 950 hospitals. 

Study results showed that the odds of being transferred to another facility were 4 times higher among patients who were uninsured, when compared to patients with private insurance. The researchers also found that when data were further narrowed to only injured children, the odds of being transferred were 1.25 times higher than patients with private insurance. 

Dr Huang stated that more extensive analysis needs to be conducted in order to determine how the transfer rate of patients with Medicaid compares with the transfer rate of patients without insurance.

“We only compared children without insurance to children with private insurance, or children with Medicaid to children with private insurance,” Dr Huang said.  “Future research needs to be conducted to address the difference between children with Medicaid and children without insurance.”

Dr Huang expressed that increased surveillance of hospitals’ compliance with the Emergency Medical Treatment and Active Labor Act needs to be implemented in order to ensure that patients without private insurance are not receiving a sub-par quality of care. 

“The government and society should work on reducing the number of children without medical insurance as well as equity in payments between Medicaid and private insurance,” Dr Huang concluded. “Further surveillance of hospitals and physicians should be monitored to identify when pediatric patients are treated differently because of their insurance status.”  —David Costill