Abstract
BackgroundIt is estimated that approximately half of emergency department (ED) usage in the U.S. and other developed countries is for non-urgent conditions and that this usage is related to availability, social, and economic factors. We examined pediatric ED usage in a U.S. state with respect to income, health insurance status, types of medical conditions, and whether introduction of managed care affected utilization by Medicaid children.MethodsEmergency department usage rates were calculated from 1996 through 1998 using Utah ED data for children with commercial health insurance, Medicaid, for uninsured children, and by income group estimating neighborhood household income from Zip code of residence. We analyzed usage following the July 1996 transition of Utah Medicaid to managed care.ResultsChildren with Medicaid had approximately 50% greater ED utilization rates than children with commercial health insurance or uninsured children. The majority of usage for Medicaid and uninsured children was for non-traumatic conditions. Only 35% of total ED usage was for non-emergent or non-urgent conditions and this was related to both Medicaid and low household income. Children lacking health insurance were more likely to be discharged against medical advice (OR = 2.36, 95% C.I. 1.88–2.96). There was no reduction in Medicaid ED usage following the transition to managed care.ConclusionUsage of ED services is related to both health insurance status and income. Children lacking health insurance and Medicaid children have excessive usage for conditions which could be treated in a primary care setting. That managed care does not reduce Medicaid ED usage is consistent with findings of other studies.
Highlights
It is estimated that approximately half of emergency department (ED) usage in the U.S and other developed countries is for non-urgent conditions and that this usage is related to availability, social, and economic factors
This study reports condition-specific data on ED usage which provide evidence that both economic status and health insurance status are related to pediatric emergency department usage
Children in upper income neighborhoods who were uninsured had usage patterns similar to insured children, while uninsured children in low income neighborhoods had usage patterns similar to Medicaid children. Both the middle and upper income neighborhoods in this study were in urban areas where walk-in urgent care centers provided an alternative source of care during weekends and evening hours. This is consistent with our finding that, regardless of insurance status, children living in high income areas were less likely to have ED visits coded as other than "emergent or urgent" than children living in low income areas
Summary
We examined pediatric ED usage in a U.S state with respect to income, health insurance status, types of medical conditions, and whether introduction of managed care affected utilization by Medicaid children. A study of the 1994 National Hospital Ambulatory Medical Care Survey found a relationship between lack of health insurance and increased ED utilization by adolescents [8]. A study of 1997 U.S data reported no relationship between health insurance status and pediatric ED utilization after controlling for covariates such as age, number of parents present in the household, ethnicity, and family income [9]. Reduction of ED utilization for non-emergent conditions has been reported following enrollment in managed care plans [10] but this has been found only in children covered by commercial health insurance and not those covered by Medicaid [11]
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