Are there disparities in emergency care for uninsured, medicaid, and privately insured patients?

To determine if there are any differences in proportion of high-acuity care and low-acuity care provided to uninsured, Medicaid-insured, and privately insured emergency department (ED) patients.

This was a retrospective, observational study using physician level of service provided as a marker for acuity. The study used computerized billing data (2000-2001) from an urban, teaching, Level I trauma center with 75,000 visits per year. All uninsured and Medicaid patients (age groups: pediatric, <18 years; adult, 18-64 years) were compared by physician level of service billed to Blue Cross-Blue Shield (BCBS) patients and analyzed using chi-square. Low-acuity care was defined by CPT codes 99281 and 99282. High-acuity care was defined by CPT codes 99285 and 99291.

There were 152,379 total ED visits, with 13.2% BCBS (5,273 pediatric, 14,951 adult), 29.6% Medicaid (20,578 pediatric, 24,511 adult), and 8.1% uninsured (1,879 pediatric, 10,405 adult) patients. The percent of pediatric BCBS, Medicaid, and uninsured patients receiving low-acuity care was 30%, 35.7%, and 35.8% (p < 0.001), respectively; and for high-acuity care, it was 7.8%, 6.1%, and 6.8% (p < 0.001), respectively. The proportion of adults within these groupings was 13.7%, 13.2%, and 17.9% (p < 0.001) for low-acuity care, and 28.5%, 22.9%, and 16.7% (p < 0.001) for high-acuity care, respectively.

Whereas there were some statistically discerned differences between insurance groupings for proportionate receipt of low-acuity care and high-acuity care among both the pediatric and adult populations, the magnitude of most differences noted was not large, and may not reflect important differences in health care need or ED use based on insurance.