Nav: Home

Study links insurance coverage to access to hospital care

April 01, 2019

New Haven, Conn. -- Compared to privately insured patients, individuals who lack insurance or use Medicaid are more likely to be transferred to another hospital after receiving initial treatment in the emergency department (ED). The uninsured are also at greater risk of being discharged from an ED and not admitted to the hospital. These findings reveal disparities in access to hospital care linked to insurance coverage, said Yale researchers.

Their study was published in JAMA Internal Medicine.

Prior research suggests that uninsured and underinsured patients were more likely to be transferred from the ED to another hospital, especially if they needed specialized care for an emergency. But other studies failed to account for differences in the ability of hospitals to provide those specialized services, such as intensive care.

To explore the issue further, the Yale researchers analyzed data from a national sample of EDs for one year. They included only hospitals that offered critical care to treat three conditions commonly seen in the ED: asthma, pneumonia, and chronic obstructive pulmonary disease.

The research team reviewed more than 200,000 ED visits and found significant differences - linked with insurance status - in whether patients were transferred, discharged, or hospitalized. "Patients who are uninsured or on Medicaid were more likely to be transferred than patients with commercial or private pay insurance," said lead author Arjun Venkatesh, M.D., assistant professor of emergency medicine. The uninsured also had half the admissions rate of privately insured patients.

While the study did not examine the cause of these disparities, financial incentives for hospitals could play a role, said Venkatesh. Hospitals are not reimbursed for admitting uninsured patients and they receive lower payments for Medicaid, he noted.

"Patients have a guarantee to emergency care, but that really only guarantees a medical screening exam. What our paper suggests is that there may be an access barrier to acute hospital care," he said.

The study authors urge policymakers to recognize this access gap through research and strategies to support coverage for the uninsured and Medicaid recipients.
-end-
Other study authors are Shih-Chuan Chou, Shu-Xia Li, Jennie Choi, Joseph S. Ross, Gail D'Onofrio, Harlan M. Krumholz, and Kumar Dharmarajan.

This study was supported in part by an Emergency Medicine Foundation Health Policy Scholar Award and a Yale Center for Clinical Investigation grant from the National Center for Advancing Translational Science of the National Institutes of Health. A full list of funders and disclosures are detailed in JAMA Internal Medicine.

Citation: JAMA Internal Medicine

Yale University

Related Emergency Department Articles:

Emoji buttons gauge emergency department sentiments in real time
Simple button terminals stationed around emergency departments featuring 'emoji' reflecting a range of emotions are effective in monitoring doctor and patient sentiments in real time.
Emergency department openings and closures impact resources for heart attack patients
A new study has found that hospital emergency room closures can adversely affect health outcomes for heart attack patients at neighboring hospitals that are near or at full capacity.
Is caregiver depression associated with more emergency department visits by patients with dementia?
An observational study of 663 caregivers and the patients with dementia they care for suggests caregiver depression is associated with increased emergency department visits for their patients.
Physical and mental illnesses combined increase emergency department visits
People with both physical illnesses and mental disorders visit the emergency department more frequently than people with multiple physical illnesses or mental illness alone, according to a study in CMAJ (Canadian Medical Association Journal).
Reducing overtesting in the emergency department could save millions
A new study finds there's excessive imaging testing being performed in the emergency department.
Canadian pediatric emergency department crowding not linked to death, serious adverse outcomes
Visiting a crowded pediatric emergency department in Canada may increase the likelihood of being hospitalized but is not linked to delayed hospitalization or death in children, according to research in CMAJ.
Obese children over a third more likely to require a hospital emergency department visit
New research presented at this year's European Congress on Obesity (ECO) in Glasgow, Scotland (April 28-May 1) reveals that obese children are over a third more likely to require a hospital emergency department visit than their normal weight counterparts.
Patients with cancer seen in the emergency department have better outcomes at original hospital
Patients with cancer requiring emergency department care had better outcomes at their original hospital or a cancer centre hospital than at alternative general hospitals, found research published in CMAJ (Canadian Medical Association Journal).
Perceptions of chronic fatigue syndrome in the emergency department
Findings from a novel online questionnaire of people with chronic fatigue syndrome (CFS) suggest the majority of these patients do not receive proper care, say researchers from Georgetown University Medical Center in the first investigation of the presentation of CFS in the emergency department.
One in 5 kids with food allergies treated in emergency department in past year
Researchers from Ann & Robert H. Lurie Children's Hospital of Chicago and colleagues estimate that nearly 8 percent of US children (about 5.6 million) have food allergies, with nearly 40 percent allergic to more than one food.
More Emergency Department News and Emergency Department Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Rethinking Anger
Anger is universal and complex: it can be quiet, festering, justified, vengeful, and destructive. This hour, TED speakers explore the many sides of anger, why we need it, and who's allowed to feel it. Guests include psychologists Ryan Martin and Russell Kolts, writer Soraya Chemaly, former talk radio host Lisa Fritsch, and business professor Dan Moshavi.
Now Playing: Science for the People

#538 Nobels and Astrophysics
This week we start with this year's physics Nobel Prize awarded to Jim Peebles, Michel Mayor, and Didier Queloz and finish with a discussion of the Nobel Prizes as a way to award and highlight important science. Are they still relevant? When science breakthroughs are built on the backs of hundreds -- and sometimes thousands -- of people's hard work, how do you pick just three to highlight? Join host Rachelle Saunders and astrophysicist, author, and science communicator Ethan Siegel for their chat about astrophysics and Nobel Prizes.