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Insurance status may influence ED experience for children with mental health diagnoses

SAN FRANCISCO — Children and adolescents who present to the ED with mental health diagnoses were more likely to be transferred to another hospital than admitted if they had Medicaid or no insurance, according to findings presented at the 2016 AAP National Conference and Exhibition.

To assess associations between insurance status and the decision to admit or transfer to another hospital in the ED among children with a primary mental health diagnosis, researchers analyzed data from the Healthcare Cost and Utilization Project 2012 Nationwide Emergency Department Sample for pediatric patients aged 17 years and younger across 950 hospitals. The sample included 20,080 pediatric mental health ED events.

Male sex and non-metropolitan hospital setting were associated with higher odds for transfer.

Participants with Medicaid (OR = 1.42; 95% CI, 1.11-1.82) and with no insurance or self-pay (OR = 3.32; 95% CI, 2.33-4.74) were more likely to transfer, compared with those with private insurance.

Participants with other insurance types had similar odds for transfer as those with private insurance (OR = 1.07; 95% CI, 0.65-1.75).

Odds for transfer varied among diagnostic categories. Compared with participants with private insurance, those with Medicaid or no insurance/self-pay were significantly more likely to be transferred for the following diagnoses: adjustment disorders (OR= 1.93; 95% CI, 1.24-3.01; OR = 5.36; 95% CI, 2.36-12.18), anxiety disorders (OR = 1.53; 95% CI, 1.13-2.07; OR = 4.87; 95% CI, 2.22-10.68), bipolar disorder (OR =1.72; 95% CI, 1.2-2.48; OR = 5.22; 95% CI, 3.3-8.27), depressive disorder (OR = 1.38; 95% CI, 1.07-1.77; OR = 2.01; 95% CI,1.33-3.04), and miscellaneous mental disorders (OR = 2.03; 95% CI, 1.06-3.89; OR = 7.01; 95% CI, 1.74-28.21).

“Pediatric patients with a primary mental health diagnosis presenting to EDs who have Medicaid or are without insurance are more likely to be transferred to another hospital than to be admitted and treated locally than similar patients with private insurance,” Kissee wrote. “This study provides evidence for the influence of non-medical factors, such as insurance status, on disparities in health care in a pediatric mental health population.” – by Amanda Oldt

Reference:

Kissee J. The association between insurance status and transfer of children with a mental health diagnosis from emergency departments. Presented at: AAP National Conference and Exhibition; Oct. 21-25, 2016; San Francisco.

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