Reasons for visits to emergency departments for Medicaid and State Children's Health Insurance Program patients:...

To describe the primary reason for visits to hospital emergency departments (EDs) by patients whose expected source of payment was Medicaid/State Children's Health Insurance Program (SCHIP). The primary reason for an ED visit is particularly important because it reflects the patients' perspective of the problem that necessitated a visit to the ED.

Retrospective study.

Data for 2004 from the National Hospital Ambulatory Medical Care Survey (NHAMCS) were analyzed for reasons for ED visits. NHAMCS is a national probability sample survey of visits to hospital EDs and outpatient departments of non-federal, short-stay, and general hospitals in the United States. Data are collected annually and are weighted to generate national estimates.

An estimated 24.5 million visits were made to hospital EDs in 2004 by patients whose expected method of payment was Medicaid/SCHIP (annual rate = 795 visits/7,000 Medicaid/SCHIP enrollees). Medicaid/SCHIP enrollees aged 25-44 years recorded the highest visit rate at 1,281 visits/1,000 persons. The rate of visits for African American Medicaid/SCHIP enrollees was 36% higher than that of whites (1,016 vs. 746 visits, respectively/1,000 persons). Nine of the 10 leading reasons for ED visits are similar for both Medicaid/SCHIP enrollees and the general population. Among Medicaid/SCHIP enrollees, the leading reason for visits include fever (54 visits/7,000 persons), stomach pain (37 visits/1,000 persons), and cough (35 visits/1,000 persons). For the general population, the leading reasons for visits include stomach pain (79 visits/7,000 persons), chest pain (19 visits/1,000 persons), and fever (74 visits/1,000 persons). For patients with an expected payment source other than Medicaid/SCHIP, 7 of the 10 leading reasons for visits are similar to Medicaid/SCHIP enrollees. For this category, the leading reason for visits are chest pain (18 visits/1,000 persons), stomach pain (16 visits/1,000 persons), and fever (70 visits/1,000 persons).

Although Medicaid/SCHIP enrollees shared the same leading reasons with the general population in their visits to EDs, they had higher rates of visits for these reasons. It is possible that the general population is making a higher proportion of visits for the same reasons to settings other than EDs, relative to the Medicaid population. Differences in the age distribution of these populations could also be a factor in the observed visit rates.