Trends in Pediatric Emergency Department Use After the Affordable Care Act

Area of Science:

• Pediatric Health Services Research
• Health Policy Analysis
• Emergency Medicine

Background:

• The Affordable Care Act (ACA) expanded health insurance coverage to 900,000 children starting in 2014.
• Previous research indicates varied impacts of insurance on adult emergency department (ED) utilization.
• The effect of the ACA on pediatric ED visit rates remains largely unknown.

Purpose of the Study:

• To examine trends in pediatric emergency department (ED) visit rates before and after the full implementation of the Affordable Care Act (ACA) in 2014.
• To determine if increased health insurance coverage influenced pediatric ED utilization.
• To analyze changes in the rate of ED visits among children post-ACA.

Main Methods:

• A retrospective, cross-sectional study design was employed.
• Data on ED visit counts were sourced from the Nationwide Emergency Department Sample.
• Population estimates from the American Community Survey were used to calculate visit rates, controlling for age, sex, and census region.

Main Results:

• The mean pediatric ED visit rate was 35.2 per 100 children (2009-2013) and 36.6 per 100 children (2014-2016).
• Annual ED visit rates increased by 1.1% pre-2014 and significantly accelerated to 9.8% annually from 2014 to 2016 (IRR 1.09, P = .005).
• These trends persisted even when insurance status was included as a covariate.

Conclusions:

• Pediatric ED visit rates did not show an immediate change in the year following ACA implementation.
• A significant acceleration in the rate of pediatric ED visits was observed between 2014 and 2016.
• Increased pediatric insurance coverage under the ACA did not appear to be a primary driver or inhibitor of these observed ED visit trends.