title: Insurance status and the care of children in the emergency department.
abstract: OBJECTIVE
  To determine whether insurance status is associated with the use of diagnostic testing or intervention in the emergency department (ED) care of children.
  
  
  METHODS
  Retrospective cross-sectional analysis of ED visits using data from the National Hospital Ambulatory Medical Care Survey (1999-2008). Children <19 years old were categorized as having private insurance, public insurance, or no insurance. The main outcome measure was the adjusted odds of testing (laboratory or radiologic) or intervention (medication or procedure), controlling for demographic, clinical, and hospital specific factors. Illness severity was controlled for using triage and admission status.
  
  
  RESULTS
  Forty-five percent (95% CI; 44, 47) of visits were characterized as having private insurance compared with 43% with public insurance (95% CI; 42, 44) and 12% without insurance (95% CI; 11, 13). Children with public insurance and no insurance received less testing compared with those with private insurance (adjusted OR 0.78, 95% CI; 0.73, 0.84 and adjusted OR 0.78, 95% CI; 0.72, 0.84, respectively). Similar patterns were seen in the use of medications and performance of procedures.
  
  
  CONCLUSIONS
  Non-private insurance status is associated with decreased utilization of diagnostic testing and intervention in children visiting the ED. It is unclear whether these patterns represent appropriate utilization, overutilization in patients with private insurance, or underutilization in patients without private insurance. Further studies are needed to evaluate whether these disparate care patterns impact health outcomes and could have important implications for the allocation of healthcare resources within the ED as well as the primary care setting.
authors.affiliation: Division of Emergency Medicine, Department of Medicine, Children's Hospital Boston, Boston, MA, USA. Rebekah.Mannix@childrens.harvard.edu
authors.forename: Rebekah
authors.initials: R
authors.lastname: Mannix
authors.forename: Vincent
authors.initials: V
authors.lastname: Chiang
authors.forename: Anne M
authors.initials: AM
authors.lastname: Stack
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000191:economics*; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D019458:Insurance Coverage; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid; D015999:Multivariate Analysis; D017149:Private Sector; D014481:United States