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Challenging assumptions about uninsured children in the pediatric emergency department
William M McDonnell1, Elisabeth Guenther
1Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT 84158, USA. william.mcdonnell@hsc.utah.edu
Insights
Uninsured children do not use emergency departments (EDs) more frequently than insured children. This study found no disproportionate representation of uninsured children in pediatric EDs, challenging assumptions about their role in ED crowding.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Health Insurance Access
Background:
- Emergency departments (EDs) face increasing patient volumes and crowding.
- The contribution of uninsured patients to ED crowding is debated, particularly for pediatric populations.
- Understanding insurance status and its impact on ED utilization is crucial for resource allocation.
Purpose of the Study:
- To compare emergency department (ED) utilization patterns between insured and uninsured children.
- To determine if uninsured children are disproportionately represented in pediatric ED populations.
- To assess if insurance status influences the frequency of ED visits among children.
Main Methods:
- A survey of parents presenting to a tertiary care pediatric hospital's ED collected data on insurance coverage and ED visit frequency.
- Hospital billing records were analyzed to validate survey findings on uninsured pediatric ED patient rates.
- Survey data on ED use were compared with state-level Census Bureau data on uninsured children.
Main Results:
- Out of 2024 surveyed children, 9.5% were uninsured, aligning with state prevalence of 13%.
- Billing records indicated 10.2% of pediatric ED patients were uninsured.
- Uninsured children did not show a greater likelihood of moderate or frequent ED use compared to insured children when insurance categories were combined.
Conclusions:
- Uninsured children are not disproportionately represented in the pediatric emergency department population.
- Insurance status does not appear to be a significant driver for moderate or frequent ED use among children.
- Findings suggest that factors other than insurance status may contribute more significantly to pediatric ED crowding.
Objective:
Emergency departments (EDs) are experiencing increased volumes and crowding problems. Although crowding is often blamed on uninsured patients, the role of uninsured children is unclear. We compared ED use by insured and uninsured children.
Methods:
Parents of children presenting at a tertiary care pediatric hospital ED were surveyed to determine health insurance coverage and frequency of ED use. Hospital billing records were reviewed separately to validate our survey results. Results were compared with Census Bureau data on the prevalence of uninsured children.
Results:
We enrolled 2024 participants in the survey arm. Of all children 48.4% (n = 972) were privately insured, 42.1% (n = 846) have government insurance, and 9.5% (n = 191) were uninsured. Billing records showed that 10.2% (n = 3825) of pediatric ED patients during the previous year were uninsured. Census data showed that 13% of children statewide were uninsured. Among survey subjects, uninsured children were more likely than privately insured children (53% vs 42%), but less likely than children with government insurance (67%), to have moderate ED use (≥1 additional ED visit in 12 months; P < 0.001) or frequent ED use (≥5 visits in 12 months; 4% vs 2% vs 8%; P < 0.001). When private and government insurance categories were combined, uninsured children showed no greater likelihood of moderate ED use (53% vs 53%, P = 0.89) or frequent ED use (4% vs 5%, P = 0.71) than insured children did.
Conclusions:
Uninsured pediatric patients were not disproportionately represented in the ED population. Moreover, uninsured children were not more likely than insured children to be moderate or frequent ED users.
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