Uninsured, Medicaid Patients More Likely to Be Transferred to Alternative Hospital

Uninsured adult patients and Medicaid beneficiaries are transferred to different hospitals more often than their insured counterparts seeking the same care, according to a JAMA Internal Medicine study.

The cross-sectional analysis, conducted by Arjun K. Venkatesh, MD, MBA, MHS, department of emergency medicine, Yale University School of Medicine, and colleagues, examined 215,028 emergency department visits to 160 United States hospitals between January 2015 and December 2015.

Researchers sought to investigate the success of Emergency Medical Treatment and Active Labor Act (EMTALA) authorized by Congress in 1986, which created a federal mandate that requires emergency departments (EDs) perform a medical screening to any patients seeking acute medical care. While the researchers note that violations of the statute are rare, there was a need to look into the common factors of patients being discharged or transferred.

The analysis focused on patients presenting with pneumonia, chronic obstructive pulmonary disease, and asthma, as most EDs have the facilities to provide adequate care and treatment is well-defined.

“Among a national sample of ED visits for common medical conditions at hospitals with critical care capabilities, we found that, after accounting for patient characteristics, both uninsured patients and Medicaid beneficiaries were more likely to be transferred to another hospital compared with those with private insurance,” said Dr Venkatesh and colleagues.

Results were consistent with previous studies conducted, however, the researchers add that their analysis confirms that patients without private insurance are being transferred more often for standard treatments, as the study excluded interhospital transfers for specialty or critical care services.

“More than 3 decades after the passage of the EMTALA, we found differences in access to hospital care based on patient insurance status, suggesting a unique modern-day barrier to hospitalization for common medical conditions,” authors of the report stated. “Policymakers should broaden the scope of hospital quality, payment, and certification initiatives to reduce these disparities and improve access to hospital-based care.”

—Edan Stanley 

Reference:
Venkatesh AK, Chou S, Li S, et al. Association Between Insurance Status and Access to Hospital Care in Emergency Department Disposition. JAMA Intern Med. Published online April 01, 2019. doi:10.1001/jamainternmed.2019.0037