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Care without coverage: is there a relationship between insurance and ED care?
Faber A White1, Daniel French, Frank L Zwemer
1Department of Emergency Medicine, University of Rochester, Strong Memorial Hospital, Rochester, New York 14642, USA.
The Journal of Emergency Medicine
|February 20, 2007
Summary
Insurance status showed limited impact on emergency department care for high-acuity patients. While fewer uninsured patients were admitted, most other care measures were similar, suggesting care differences may not start in the ED.
Area of Science:
- Health Services Research
- Emergency Medicine
- Health Equity
Background:
- The Institute of Medicine (IOM) identified disparities in hospitalized patient care based on insurance status.
- Previous research indicates potential inequities in healthcare access and treatment.
- The emergency department (ED) is a critical access point for acute care, necessitating an examination of potential insurance-based disparities at this level.
Purpose of the Study:
- To investigate whether differences in emergency department (ED) care for high-acuity patients are associated with insurance status.
- To determine if insurance-based disparities in care begin at the ED level, prior to hospital admission.
Main Methods:
- Retrospective study of high-acuity adult visits to a single ED over six months.
- Utilized electronic databases to collect data on patient demographics, insurance status, and care processes.
- Compared care measures between insured and uninsured patient groups, including admission rates and diagnostic study utilization.
Main Results:
- Uninsured patients were younger, more often male, and non-white compared to insured patients.
- Significantly fewer uninsured patients were admitted from the ED (9.8%) compared to insured patients (27.2%).
- Most care measures showed no significant difference between insured and uninsured patients, except for radiographic studies, which were utilized less in uninsured patients across both admitted and treated-and-released groups.
Conclusions:
- This pilot study found limited evidence of insurance-based differences in most measures of emergency department care for high-acuity patients.
- While admission rates differed, other aspects of ED care, such as diagnostic testing, showed minimal disparities.
- Further research is needed to fully understand the impact of insurance status on emergency care and to address any identified inequities.
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