Individual Social Determinants of Health and Location of Pediatric Low-Resource-Intensity Care

To examine the association between social determinants of health and location of pediatric low-resource-intensity visits, and to quantify associated reimbursement.

We performed a cross-sectional, nationally representative survey study of nonelective visits for patients ≤18 years old in the 2019-2021 Medical Expenditure Panel Survey. The primary outcome was emergency department (ED) or outpatient location of low-resource-intensity visits (visits with no labs, imaging, procedures, or resultant hospitalization). The relationship between location and social determinants was determined with logistic regression. The secondary outcome was reimbursement related to these visits.

A total of 23 231 observations representing 96 155 173 visits were included. Of these, 3.2% were to the ED. Among social determinants of health, lower education, public insurance, and lack of primary care were associated with ED presentation; family income and language were not. Reimbursement for ED visits was 544.3% higher than outpatient visits, accounting for $546 million in yearly excess health care costs.

Lower family educational attainment, public insurance status, and poor access to primary care demonstrated significant associations with ED presentation for low-resource-intensity visits. These results suggest that interventions to reduce these visits, which could improve disparities and reduce unnecessary medical spending, should address modifiable factors such as access to primary care.