MedicalResearch.com Interview with:
Ph.D. Candidate in epidemiology
Department of Pediatrics
University of California
Davis, Sacramento, CA
MedicalResearch.com: What is the background for this study?
Response: Each year, more than 27 million children seek care in emergency departments (EDs) in the United States. Many EDs, however, are not fully equipped with the recommended pediatric supplies and may not have access to the pediatric specialists and resources needed to provide definitive care. As a result, many children receiving treatment in EDs of hospitals with limited pediatric resources are transferred to another hospital’s ED or inpatient unit for admission.
The Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospitals to make decisions on patient transfer and admission independent of insurance status. That is, the decision to transfer a patient to another hospital for admission should only depend upon clinical factors or the need for specialty services. However, patterns observed in the medical literatures have suggested that a child’s insurance status could be associated with transfer and admission decisions. These studies have been limited to single institutions and/or have been limited to specific conditions._ENREF_14 Whether or not transfer decisions among pediatric patients are related to insurance status has yet to be studied on a national level and across a variety of diagnoses.
We used Healthcare Cost and Utilization Project 2012 Nationwide Emergency Department Sample data and sought to investigate the relationships between insurance status and odds of transfer relative to local admission among pediatric patients receiving care in the ED.
MedicalResearch.com: What are the main findings?
Response: Among non-injured children, 240,620 pediatric ED visits at 950 hospitals located in 30 U.S. states, we found that patients who were uninsured or reported as self-pay had almost four times the odds of being transferred relative to admission compared to those with private insurance. This association was evident across all thirteen diagnostic categories studied. Among injured children, which included data from 9,461 ED encounters at 386 non-trauma centers, we found patients with Medicaid had 1.25 times the odds of being transferred to another facility relative to admission compared to patients with private insurance.
MedicalResearch.com: What should readers take away from your report?
Response: Our findings suggest a systematic bias toward admitting children with private medical insurance and/or transferring those without insurance or with Medicaid. These findings reinforce ongoing concerns about disparities in the provision of pediatric ED and inpatient care, and also call into question of the three-decade-old EMTALA requiring hospitals to make decisions on patients’ transfer or admission independent of their insurance status.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Emergency Departments and hospitals should be monitored for appropriate and inappropriate admissions and transfers based upon patients’ insurance status. Further researches are needed to evaluate the impact of admission and transfer decisions on pediatric patient outcomes and costs of care.
MedicalResearch.com: Is there anything else you would like to add?
Response: The impact of the affordable care act, which has significantly reduced the number of uninsured is not yet known. Efforts should be made to reduce the number of medically uninsured as well as to address disparities in insurance payments for care.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Citation: Abstract presented at the 2016 AAP meeting
Association between Insurance and Transfer of Children from Emergency Departments” on Monday, Oct. 24, at 9:15 am PT in Mascone Center West room 2018. For a copy of the abstract, contact the AAP Department of Public Affairs at 948-434-7877 or firstname.lastname@example.org
Ann Emerg Med. 2016 Aug 20. pii: S0196-0644(16)30262-1.
doi: 10.1016/j.annemergmed.2016.06.007. [Epub ahead of print]
The Association Between Insurance and Transfer of Noninjured Children From Emergency Departments.
Huang Y1, Natale JE2, Kissee JL2, Dayal P2, Rosenthal JL2, Marcin JP2.
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.
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