Insurance Eligibility of Adult Emergency Department Patients

Area of Science:

• Public Health
• Health Services Research
• Health Economics

Background:

• Inner-city emergency departments (EDs) serve a vulnerable patient population.
• Understanding insurance eligibility is crucial for patient care and hospital finances.
• The study was conducted before the implementation of the Affordable Care Act.

Purpose of the Study:

• To assess the eligibility of uninsured patients in an inner-city ED for government-sponsored insurance programs.
• To identify opportunities for improving healthcare access for the uninsured.

Main Methods:

• A survey was administered to uninsured adult ED patients (age ≥19) deemed eligible for discharge.
• Trained students collected data on demographics and income to determine insurance eligibility.
• Exclusion criteria included acute illness, confusion, intoxication, and other factors preventing survey completion.

Main Results:

• Out of 132 participants, 114 (86.4%) were found to be eligible for government insurance.
• A statistically significant difference in median income was observed between eligible ($2,300) and ineligible ($17,388) patients (p<0.0001).

Conclusions:

• EDs can play a vital role in identifying uninsured patients eligible for government insurance.
• Assisting patients with insurance applications can increase access to care and provide hospitals with reimbursement.
• This highlights a missed opportunity for healthcare systems to connect vulnerable populations with essential coverage.