Children's health insurance status and emergency department utilization in the United States

Xuemei Luo, Gordon Liu, Karen Frush, Lloyd A Hey
Pediatrics 2003, 112 (2): 314-9

OBJECTIVES: Emergency department (ED) overcrowding has become a national problem. Children account for nearly 25% of overall ED visits. It has been reported that uninsured and publicly insured children are likely to visit the ED for urgent and nonurgent problems, yet it remains unclear to what extent health insurance status would influence children's overall ED utilization or ED utilization for nonurgent problems at the national level after controlling for other confounding factors. The objective of this study was to examine the effect of health insurance status on children's overall ED utilization and children's ED utilization for nonurgent problems among the general pediatric population in the United States.

METHODS: Secondary analysis of the household component of the 1997 Medical Expenditure Panel Survey on 10 193 children younger than 18 years. The main outcome measures were annual overall ED utilization and ED utilization for nonurgent problems.

RESULTS: During 1997, 10.8% of children were uninsured for the entire year. A total of 17.5% of children were publicly insured the entire year, whereas 55.3% of children held private insurance the entire year. There were also 16.5% of children who were insured only part of the year. Without adjusting for covariates, publicly insured children were more likely to have an ED visit during the year than both privately insured children (unadjusted odds ratio [OR]: 1.26; 95% confidence interval [CI]: 1.03-1.55) and uninsured children (unadjusted OR: 1.46; 95% CI: 1.1-1.95). The difference between publicly insured and privately insured children (adjusted OR: 0.90; 95% CI: 0.70-1.16) and between publicly insured and uninsured children (adjusted OR: 1.12; 95% CI: 0.84-1.49) became insignificant after controlling for covariates. With or without adjustments for covariates, there was no significant difference in the likelihood of having an ED visit between privately insured and uninsured children. Similar to the utilization pattern of overall ED visits, publicly insured children were more likely to have a nonurgent ED visit than both privately insured (unadjusted OR: 1.86; 95% CI: 1.36-2.53) and uninsured children (unadjusted OR: 1.81; 95% CI: 1.15-2.84). Both differences disappeared after controlling for covariates. There was no significant difference in the likelihood of nonurgent ED visits between privately insured and uninsured children with or without adjustments for covariates.

CONCLUSIONS: Health insurance status was not associated with children's overall ED use or children's ED use for nonurgent problems at the national level. Our findings suggest that policy efforts in an attempt to relieve ED overcrowding conditions should look for measures beyond solely making changes in health insurance coverage for children.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Trending Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"