The influence of insurance status on nonurgent pediatric visits to the emergency department.
OBJECTIVE
To compare the effects of HMOs with the effects of other types of private health insurance on nonurgent ED visits in the pediatric population.


METHODS
Secondary analysis of the emergency component of the 1994 National Hospital Ambulatory Medical Care Survey (NHAMCS) on patients aged 15 years or less. Variables of interest included urgency of visit, age, sex, race, ethnicity, method of payment (HMO, private insurance/non-HMO, and others), and chief complaint. A p-value of 0.01 was used as the threshold for significance to offset the effects of increases in variability and significance of p-values and narrow confidence intervals.


RESULTS
There were 6,744 observations. The overall rate of nonurgent ED visits was 58%. The rate of nonurgent visits for HMO patients was 51%, for private non-HMO insurance 56%, and for other types of payment (Medicare, Medicaid, patient paid, no charge, and other government) 60%. Chief complaints for nonurgent visits were general symptoms, EENT (ear, eyes, nose, and throat) symptoms, and dermatologic symptoms. After multivariate analysis, the odds ratio for patients with private insurance for a nonurgent visit compared with HMO patients was 1.27, with a 95% CI = 1.07 to 1.51, after adjusting for age, sex, and chief complaint.


CONCLUSIONS
Pediatric patients with private insurance were more likely to present for emergency care for nonurgent reasons when compared with HMO patients after adjusting for the above listed variables. The reasons for this disparity should be further explored.
Fong
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Division of Emergency Medicine, Children's Hospital, Harvard Medical School, Boston, MA, USA. cfong@cwcom.net
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006300:Health Services Misuse / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007348:Insurance, Health / Q000145:classification / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D012189:Retrospective Studies; D014481:United States