Type of Insurance Affects Emergency Department Wait Time
Since 1986 when the Emergency Medical Treatment and Labor Act was passed, ensuring that any patient that arrives must be treated regardless of insurance status, emergency departments (EDs) have been an important part of the healthcare system and the demand for healthcare services. As the need for emergency services and their costs continue to rise, patients at EDs are facing long waits and medical professionals are finding themselves weighed down by overcrowding.
Many studies have documented the overcrowding issue; however, a recent study examined the impact of ED overcrowding regarding wait times and patient outcomes dependent upon different forms of health insurance [Health Econ Rev. 2013;3(1):25]. The study included a unique cross section of approximately 32,000 patients for an ED located in the southwestern region of the United States.
Previous studies have indicated that individuals with lower incomes are often more impacted by long waits and overcrowding, as these are the patients who are at risk of preventable negative outcomes.
The recent study by Pedro de Araujo et al culled data from an ED located in a level 1 trauma facility in an urban, low socioeconomic demographic of the southwestern United States between January 1, 2011, and October 1, 2011. The components of data collected included patient check in time, time they were assesses by a physician, the acuity of the initial complaint, checkout time, and final disposition.
According to the authors, in the study sample, an average of 219 patients check into the ED daily, and patients spend an average 3.9 hours in the ED. Patients waited on average more than 30 minutes to see a doctor, with the maximum amount of time spent waiting was more than 6 hours. Approximately 16% of the patients included in the study had no insurance, while 18% had private insurance. See Table for a list of patient insurance types.
The mean patient age was 43 years, approximately 42% were male, approximately 42% had Medicaid coverage, and 40% were white.
The following variables were considered negative outcomes in the study: patient died, eloped, left against medical advice, or left without seeing a doctor. The study estimated results for traditional ordinary least squares and a 2-stage least squares where time waited was instrumental for using overcrowding. The study estimated a standard Probit model and an instrumental variable Probit model (IV Probit) due to the binary nature of the study.
According to the study specifications, longer wait times lead to an increase in the likelihood of negative outcomes for patients. The study found that having insurance alleviated some of the negative impacts; however, patients with Medicaid or no insurance had exacerbated negative outcomes when compared to their Medicare and private insurance counterparts.
The results of the IV Probit suggest that waiting an extra hour at the ED increases the likelihood of a negative outcome by 1.9%. Patients with private insurance or Medicare had decreased likelihood of a negative outcome by 0.6% and 0.8%, respectively. Patients with no insurance experienced a .14% increase in the likelihood of a negative outcome. This is notable since uninsured individuals typically do not have access to health services other than the ED.
The study also found that patients with primary doctors had better ED outcomes. The study authors attributed this to the fact that patients with primary doctors get regular checkups, are more health conscious, and tend to use the ED more appropriately.
The following additional variables were associated with increased likelihood of a negative outcome: having acute health conditions, being older age, being male, or being black.
Overall, the study authors concluded that waits based on ED overcrowding generally have a negative outcome on patients. Patients with negative outcomes more often tended to be for those on Medicaid or who had no insurance, while patients with Medicare and private insurance did not have as many negative outcomes.
