Care without coverage: Is there a relationship between insurance and ED care?

White, F. A.; French, Daniel; Zwemer, Frank L.; Fairbanks, Rollin J.

doi:10.1016/j.jemermed.2006.05.043

Cited by 28 publications

(22 citation statements)

References 11 publications

(12 reference statements)

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“…[25][26][27][28] A study by Svenson et al [25] demonstrated that insurance status was an independent predictor for admission among those with head injuries. In a similar study by White et al, [26] the opposite was observed with no difference in admission for both the general population or in a subset of severely injured trauma patients. A third study, by Ruger et al, [27] observed that the insured had an increased likelihood of admissions to the general hospital, but not the ICU or operating room.…”

Section: Discussionmentioning

confidence: 99%

Identifying disparity in emergency department length of stay and admission likelihood

Dev

Mahan

et al. 2016

World Journal of Emergency Medicine

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BACKGROUND:To assess whether insurance status has an effect on emergency department (ED) length of stay (LOS) and likelihood for admission or transfer to an operating room. METHODS:This was a retrospective cross-sectional study of all encounters from January 2011 through October 2013 at an urban, academic trauma center. Analysis included multi-variable linear regression for ED LOS and logistic regression for the likelihood of admission. RESULTS:Overall, 201 535 patients met the inclusion criteria, for which the mean age was 43.8 years, 55.9% were female, 23.4% were uninsured and 8% were of non-black race. Admission rate was 24.5% and operative rate was 1.4%. After adjusting for age, sex, triage acuity and race, the presence of insurance coverage was associated with an increased ED LOS of 575 (95%CI 552-598) vs. 567 (95%CI 543-591) minutes (P<0.01) among admitted patients and a decreased ED LOS of 456 (95%CI 381-531) vs. 499 (95%CI 423-575) minutes (P<0.01) among those transferred to an operating room. Adjusting for these same predictors, insured status remained a predictor for admission (odds ratio 1.24, 95%CI 1.20-1.28, P<0.01) and a negative predictor for transfer to the operating room (odds ratio 0.84, 95%CI 0.77-0.92, P<0.01). CONCLUSION:The insured experienced a clinically insignificant increase in ED LOS when admitted and a 43-minute decrease in ED LOS when being transferred to the operating room. The insured were more likely to be admitted and less likely to be transferred to an operating room.

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Section: Discussionmentioning

confidence: 99%

Identifying disparity in emergency department length of stay and admission likelihood

Dev

Mahan

et al. 2016

World Journal of Emergency Medicine

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“…According to the Institute of Medicine, hospitalized trauma patients were found to have differences in care based on payer (insurance) status [15]. A study of 16,562 visits to the emergency department at a single tertiary care teaching hospital showed that in patients with similar ISS, uninsured patients received significantly fewer radiographic studies compared with insured patients, although no differences were elucidated in other processes of care [15]. Thus injuries and potentially fatal conditions (ie, deep vein thrombosis, pulmonary embolism) could be missed or underdiagnosed in this population.…”

Section: Discussionmentioning

confidence: 99%

Lack of insurance negatively affects trauma mortality in US children

Rosen

Saleh

Lipsitz

et al. 2009

Journal of Pediatric Surgery

112

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“…Despite guaranteed access to care, as mandated by the Emergency Medical Treatment and Active Labor Act, uninsured TBI patients have increased mortality rates. Evidence suggests that delay in treatment [18], difference in care regarding lower procedure utilization rates among African Americans [19], difference in care with respect to nonwhites being more likely to receive Emergency Department care by a resident physician (AOR 3.09 95% CI 1.9-5.0, P < 0.0001) [8], decreased health literacy [20], and language barriers [14] as well as prejudice, bias, and stereotyping on the part of health care providers may contribute to these disparities [11,21].…”

Section: Discussionmentioning

confidence: 99%