Uninsured adults presenting to US emergency departments - Assumptions vs data
ABSTRACT Emergency departments (EDs) are experiencing increased patient volumes and serve as a source of care of last resort for uninsured patients. Common assumptions about the effect of uninsured patients on the ED often drive policy solutions.
To compare common unsupported statements about uninsured patients presenting to the ED with the best available evidence on the topic.
OVID search of MEDLINE and MEDLINE in-process citations from 1950 through September 19, 2008, using the terms (Emergency Medical Services OR Emergency Service, Hospital OR emergency department.mp OR emergency medicine.mp OR Emergency Medicine) AND (uninsured.mp OR medically uninsured OR uncompensated care OR indigent.mp OR uncompensated care.mp OR medical indigency).
Of 526 articles identified, 127 (24%) met inclusion/exclusion criteria. Articles were included if they focused on the medical and surgical care of adult (aged 18 to <65 years) uninsured patients in emergency settings. Excluded articles involved pediatric or geriatric populations, psychiatric and dental illnesses, and non-patient care issues.
Statements about uninsured patients presenting for emergency care that appeared without citation or that were not based on data provided in the articles were identified using a qualitative descriptive approach based in grounded theory. Each assumption was then addressed separately in searches for supporting data in national data sets, administrative data, and peer-reviewed literature.
Among the 127 identified articles, 53 had at least 1 assumption about uninsured ED patients, with a mean of 3 assumptions per article. Common assumptions supported by the evidence include assumptions that increasing numbers of uninsured patients present to the ED and that uninsured patients lack access to primary care. Available data support the statement that care in the ED is more expensive than office-based care when appropriate, but this is true for all ED users, insured and uninsured. Available data do not support assumptions that uninsured patients are a primary cause of ED overcrowding, present with less acute conditions than insured patients, or seek ED care primarily for convenience.
Some common assumptions regarding uninsured patients and their use of the ED are not well supported by current data.
[Show abstract] [Hide abstract]
ABSTRACT: The Affordable Care Act (ACA) extended eligibility for health insurance for young adults ages 19-25. This extension may have affected how young adults use emergency department (ED) care and other health services. To test the impact of the ACA on how young adults used ED services, we used 2009-11 state administrative records from California, Florida, and New York to compare changes in ED use in young adults ages 19-25 before and after the ACA provision was implemented with changes in the same period for people ages 26-31 (the control group). Following implementation of the ACA provision, the younger group had a decrease of 2.7 ED visits per 1,000 people compared to the older group-a relative change of -2.1 percent. The largest relative decreases were found in women (-3.0 percent) and blacks (-3.4 percent). This relative decrease in ED use implies a total reduction of more than 60,000 visits from young adults ages 19-25 across the three states in 2011. When we compared the probability of ever using the ED before and after implementation of the ACA provision, we found a minimal decrease (-0.4 percent) among the younger group compared to the older group. This suggests that the change in the number of visits was driven by fewer visits among ED users, not by changes in the number of people who ever visited the ED.Health Affairs 09/2014; 33(9):1648-54. DOI:10.1377/hlthaff.2014.0103 · 4.32 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: It is a well-known fact that uninsured individuals in US are of lower socioeconomic status and that these individuals often are overrepresented at the emergency departments. We investigate if we find a similar pattern in Norway where health care is tax-financed, free of charge at the point of use, hospitals are publicly owned and funded by the government, and access to health care is (supposed to be) independent of socioeconomic status. We find substantial differences between socioeconomic groups in the number of emergency treatments relative to planned treatments, with patients with high income and tertiary education having considerably lower share of emergency treatments than patients with low income and primary education. This result suggests that lack of comprehensive health insurance is unlike to be the only reason why persons with low socioeconomic status are overrepresented in emercency departments.
JAMA Internal Medicine 09/2014; 174(11). DOI:10.1001/jamainternmed.2014.1174 · 13.25 Impact Factor