Medicaid/State Children's Health Insurance Program patients and infectious diseases treated in emergency departments:...

Emergency departments (EDs) are a critical source of medical care in the U.S. Information is sparse concerning infectious disease visits among Medicaid entitlement enrollees nationwide. The objective of this study was to describe infectious diseases in terms of Medicaid/State Children's Health Insurance Program (SCHIP) as an expected source of payment.

Data for 2003 from the National Hospital Ambulatory Medical Care Survey (NHAMCS) were analyzed for infectious disease visits. NHAMCS is a national probability sample survey of visits to hospital EDs and outpatient departments of nonfederal, short-stay, and general hospitals in the U.S. Data are collected annually and are weighted to generate national estimates.

Nationally in 2003, an estimated 21.6 million visits were made to hospital EDs for infectious diseases (rate = 76 visits/1,000 people). Medicaid/SCHIP was the expected source of payment for an estimated 6.7 million infectious disease-related visits (rate = 200 visits/1,000 people covered by Medicaid). Children aged < 15 years made 39% of visits nationwide (nationwide rate = 139 visits/1,000 people). Of Medicaid visits, 63% were made by children < 15 years of age (Medicaid enrollees rate = 255 visits/1,000 people). The rate of visits for Medicaid enrollees was comparable for females and males (198 visits vs. 201/1,000 people). The rate of visits for black Medicaid enrollees was 33% higher than for white Medicaid enrollees (255 vs. 192 visits/1,000 people). Upper respiratory tract infection (URTI) is the most frequent infectious condition recorded at ED visits. An estimated 47% of ED visits with an expected pay source of Medicaid relate to URTIs (93 visits/1,000 people), compared with 38% of ED visits in general (29 visits/1,000 people).

Medicaid enrollee-specific ED visit rates for infectious diseases were higher by age group, gender, race, and region, compared with national rates. Because approximately half of visits relate to URTIs for a Medicaid payment group, URTIs should form the basis for development of appropriate control strategies.