When it comes to being discharged straight from the emergency room or transferred to another hospital after stabilization, uninsured or Medicaid patients are more likely to be discharged than privately insured patients, JAMA International study finds Recently published medicine.
The study, which analyzed 215,000 emergency room visits to 160 US hospitals, was conducted to determine whether insurance status appeared to affect where patients were referred after their emergency room visit. Although current 1986 policy requires that all patients be seen and treated for an emergency in an emergency department, there is no mandate against transfers once the patient is stable.
Previously collected data showed that uninsured and underinsured patients, such as Medicaid recipients, especially those requiring specialist care for severe trauma or psychiatric and kidney emergencies, were more likely to be transferred than admitted. compared to patients with private insurance or Medicare coverage. However, these studies did not take into account the capacities of each hospital. This most recent report from JAMA limited its findings to traditional intensive care needs that typically do not require a specialty, such as emergency room visits for pneumonia, asthma, and chronic obstructive pulmonary disease.
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The study was set up to make conservative estimates and yet found a considerable difference in emergency transfers for uninsured and insured patients, said Arjun Venkatesh, MD, assistant professor of emergency medicine at the Yale University School of Medicine and co-author of the report. . In addition, he was surprised that this unique look at discharges also turns out to be disproportionate among insured and uninsured patients.
“The glaring differences based on the differences in insurance lead us to ask, ‘Is it time to start thinking about access to health care? “Venkatesh told FierceHealthcare. In the United States over the past decade, access has been of much less concern.
Looking at the results at the hospital level, substantial variation was observed in emergency department transfers and hospital admission rates. The median emergency room discharge rates were approximately 66.2%, the referral rate was 1.3%, and the hospital admission rate was 32.3%. Therefore, discharge rates were significantly higher than admissions or transfers. The odds of an ER transfer for uninsured patients were lower than those for privately insured patients in nonprofit hospitals.
When insurance kicked in, 88.8% of uninsured patients and 80.2% of Medicaid patients were discharged more often compared to 78.5% of privately insured patients.
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“These findings are consistent with studies conducted over the past decade and support the belief that financial incentives, or a patient’s ability to pay, may be associated with hospitalization decisions,” the study concluded.
Additionally, the data shows that uninsured patients were more likely to be discharged from the emergency department, even though this population is more likely to have serious illness. Essentially, while emergencies can no longer turn away uninsured or underinsured people, it appears that this discrimination has just been moved to the admissions stage of the process.
Given the results, Venkatesh believes policymakers need to start placing more emphasis on access to care.
“Over the past 30 years, healthcare systems have evolved and we have made significant strides in acute emergency care,” he said. “Now it’s probably time to think about the disparities and access to health care.”