NEWS | October 24, 2016

New research finds uninsured children more often transferred from ERs than those with private insurance

(SACRAMENTO, Calif.)

Photo of Jim Marcin and Yunru Huang
Huang won Best Abstract at the American Academy of Pediatrics Section on Critical Care on Oct. 24.

New research, published in an abstract authored by Yunru Huang, a Ph.D. candidate in epidemiology at University of California, Davis, shows children seen in emergency departments who don't have insurance, or who have public Medicaid coverage, are significantly more likely to be transferred to another facility than children with private insurance. Huang is presenting the abstract, “Association between Insurance and Transfer of Children from Emergency Departments," today at the American Academy of Pediatrics (AAP) 2016 National Conference & Exhibition in San Francisco.

"Our findings suggest a systematic bias toward admitting children with private medical insurance and transferring those who either don't have insurance or who have Medicaid," said Huang. The results underscore concerns about inequities in the delivery of care and call into question the effectiveness of the Emergency Medical Treatment and Active Labor Act (EMTALA), Huang said. EMTALA requires hospitals to make decisions on patient transfer and admission based on clinical factors or the need for specialty services, independent of insurance status.

The study used data from 950 hospitals in 30 states included in the Healthcare Cost and Utilization Project 2012 Nationwide Emergency Department Sample. Insurance status categories included Medicaid, uninsured, private or “other insurance.” After adjusting for injury severity and other variables, researchers found patients with Medicaid had 1.25 times the odds of being transferred to another facility for admission compared to patients with private insurance. The odds were similar for patients who were uninsured or who had other insurance, Huang said.

"Not having health insurance or having Medicaid coverage unfortunately is still an important factor in the type and quality of care delivered to children," Huang said.