ED treatment varies according to insurance status

The Emergency Department (ED) is often the place those without a primary care physician go for diagnoses and treatment. However, the researchers found that children with private, public, and no insurance may receive differing levels of treatment in EDs. The study will appear in The Journal of Pediatrics. Rebekah Mannix, MD, MPH, and her team from Children's Hospital Boston conducted a retrospective study using the National Hospital Ambulatory Medical Care Survey. The team evaluated 84,536 ED visits of children under the age of 18 in 1999-2008. The researchers found that: 45% of children in the ED had private insurance 43% of children had public insurance (Medicaid or State Children's Health Insurance Program) 12% of children had no insurance. Furthermore, the team found that children with public or no insurance were nearly 25% less likely to receive testing, a medication or undergo any procedure in the ED than children with private insurance. Compared with children with private insurance, those with public insurance were 20% more likely to be diagnosed with a serious illness. However, the researchers found no difference in the level of treatment children with significant illnesses received based on insurance status. According to the researchers, it is unclear if these differences represent appropriate care for all, over treatment in children with private insurance, or under treatment in those without private insurance. Dr. Mannix explained: "Because ED physicians are salaried or paid by the hour, it is uncertain how or why a child's insurance status could be associated with care decisions in the ED."