title: Care without coverage: is there a relationship between insurance and ED care?
abstract: The Institute of Medicine (IOM) has concluded that differences in care exist for hospitalized patients on the basis of insurance; we attempted to determine if these differences begin in the emergency department (ED). We retrospectively studied high-acuity adult visits to one ED over 6 months, utilizing electronic databases. Uninsured patients were more often younger, male, and non-white (n = 3899 visits; 468 uninsured, 3431 insured). Fewer uninsured patients were admitted (9.8% vs. 27.2% insured; p < 0.001). Comparing patients by admission status, there was no evidence of difference for most measures, excepting radiographic studies (admitted patients: 78.3% uninsured vs. 90.5% insured, p = 0.007; treated-and-released patients: 62.3% uninsured vs. 69.4% insured, p = 0.004). In a subset of trauma patients for whom acuity could be evaluated with Injury Severity Scores (ISS), admission rates were similar. In this pilot study of high-acuity patients, there was limited evidence of differences in most measures of ED-based patient care on the basis of insurance status.
authors.affiliation: Department of Emergency Medicine, University of Rochester, Strong Memorial Hospital, Rochester, New York 14642, USA.
authors.forename: Faber A
authors.initials: FA
authors.lastname: White
authors.forename: Daniel
authors.initials: D
authors.lastname: French
authors.forename: Frank L
authors.initials: FL
authors.lastname: Zwemer
authors.forename: Rollin J
authors.initials: RJ
authors.lastname: Fairbanks
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D038801:International Classification of Diseases; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D010865:Pilot Projects; D012189:Retrospective Studies