Better Access to Care Doesn't Mean Better Outcomes
Insured children who show up in the emergency department are more likely to be admitted to the hospital than those covered by Medicaid and CHIP. But they don't fare any better than those sent home.
Much of healthcare reform is about matching patients to the most appropriate care. Recent studies looking at emergency department admissions offer evidence of how hard that can be.
In New Jersey, an analysis of more than 3 million ED cases found that children with public insurance were less likely to be admitted to hospital, especially during flu season when beds tend to be full.
However, based on data including readmission rates, those who did not stay overnight suffered no bad health outcomes, according to research published in Economics and Human Biology.
The patients who were not admitted via the ED had the same rate of future visits and subsequent admissions as those who were hospitalized. Since the hospitalized patient got no benefit, the authors suggest the finding could be evidence of unnecessary care.
To establish whether unnecessary care is occurring, researchers would have to look at clinical data rather than the claims data used in this study, said Princeton University health economist Janet Currie, a coauthor of the study.
If patients did need additional care, it would show up in the data on subsequent admission and ED visits, Currie said. "If I am really sick and I get sent home, I should end up coming back," she said. "But they're not coming back… What we infer from that is they don't really need to be hospitalized."
While the publicly insured have less access to after-hours and specialist care, once admitted, they receive the same care as privately insured children. However, little research has been done on access to hospital care for publicly insured children, the researchers noted.
The statewide data used in the study covered 2006 through 2012 and looked at claims data for more than 3 million patients. They found the widest difference in admission probability (4.4 versus 4.7) during flu season—or 9,700 more publicly insured children who were not hospitalized.
A Different Twist
A slightly different twist on the impact of insurance in emergency care come from a 2014 study which found that insured patients with severe injuries who were initially evaluated at non-trauma center EDs were less likely to be transferred to trauma centers.