Association Between Insurance Status and Access to Hospital Care in Emergency Department Disposition

Area of Science:

• Health Services Research
• Emergency Medicine
• Health Economics

Background:

• Emergency department (ED) transfers of uninsured patients are increasing, potentially driven by financial incentives.
• Understanding transfer and discharge patterns by insurance status is crucial for equitable care delivery.
• Hospitals with intensive care capabilities are central to managing complex medical conditions.

Purpose of the Study:

• To investigate disparities in risk-adjusted transfer and discharge rates among emergency department patients based on insurance status.
• To compare outcomes for uninsured, Medicaid, Medicare, and privately insured patients at critical care-capable hospitals.
• To analyze the influence of hospital ownership on patient disposition from the ED.

Main Methods:

• Cross-sectional analysis of the 2015 National Emergency Department Sample.
• Included adult ED visits for pneumonia, COPD, and asthma at hospitals with intensive pulmonary care capabilities.
• Primary outcomes: risk-adjusted ED discharges, transfers, and hospital admissions; secondary analysis by hospital ownership.

Main Results:

• Uninsured patients were significantly more likely to be discharged (OR, 1.66) and transferred (aOR, 2.41) compared to privately insured patients.
• Medicaid beneficiaries showed similar discharge odds (aOR, 1.00) but higher transfer odds (aOR, 1.19) than privately insured patients.
• Substantial variation in discharge, transfer, and admission rates was observed across different emergency departments.

Conclusions:

• Uninsured patients and Medicaid beneficiaries with common acute pulmonary conditions have increased odds of interhospital transfer.
• These findings persist after controlling for hospital critical care capacity and patient case mix.
• The results suggest potential inequities in emergency care access and patient disposition based on insurance status.