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ED visits increased among children in California, regardless of insurance type
From 2005 to 2010, ED visits in California significantly increased among children across all insurance types, including those without insurance, according to study findings published in JAMA.
Renee Y. Hsia, MD, MSc, of the University of California, San Francisco, and colleagues analyzed California Office of Statewide Health Planning and Development’s Emergency Discharge and Patient Discharge data for children, adolescents and young adults aged 18 years and younger who visited the ED in acute care hospitals across California between 2005 and 2010. Visits were categorized as Medicaid, private insurance, uninsured and other.
Renee Y. Hsia
In 2010, 2.8 million children visited the ED in California, compared with 2.5 million in 2005, indicating an increase of 11%.
Children with Medicaid accounted for 44% of ED visits overall. Distribution of visits across insurance groups varied among the study period. Children with Medicaid accounted for a larger distribution of ED visits over time.
Adjusting for population, ie, a 3% decrease in the pediatric population during the study period, ED visit rates increased across all insurance groups (P<0.001 among all groups). There was a significant increase in ED utilization during 2009.
Uninsured children experienced the fastest increase in ED visit rates at about 22.7%, followed by children with private insurance who had an increase of 15%. Children with Medicaid experienced the slowest increase in ED visit rates, approximately 7.4%, yet remained highest in absolute terms.
The largest increases in ED visits were among children with private insurance or no insurance. Shifts in insurance types during the 2007 to 2009 recession may have influenced trends during this time, according to researchers.
“These findings suggest that the drivers for ED use differ significantly between youths and adults and that policies regarding insurance expansion may also have varying effects. The divergence from older trends in ED use among youths may also reflect the increasingly central role of the ED in the US health care system, especially during a period of severe economic recession, and could signal an overall deterioration in access to primary care across payer groups, or that even privately insured youths with greater access to primary care physicians are being directed to the ED for care,” the researchers concluded.
Disclosure: The researchers reported no relevant financial disclosures.
