Patient Insurance Profiles: A Tertiary Care Compared to Three Freestanding Emergency Departments.
BACKGROUND
It has been speculated that freestanding emergency departments (FEDs) draw more affluent, better-insured patients away from urban hospital EDs. It is believed that this leaves urban hospital-based EDs less financially secure.


OBJECTIVE
We examined whether the distribution of patients with four types of insurance (self-pay, Medicaid, Medicare, and private) at the main ED changed after opening three affiliated FEDs, and whether the insurance type distribution was different between main ED and FEDs and between individual FEDs.


METHODS
A retrospective analysis of insurance status of all patients presenting to our EDs from July 2006 through August 2013. Insurance was divided into self-pay, Medicare, Medicaid, and private insurance across three time periods, which reflect the sequential opening of each FED. Insurance types for each facility were compared for individual time periods and across time periods. χ2was used to analyze the data.


RESULTS
In the three studied time frames (periods B, C, and D), there were less privately insured patients and more self-pay, Medicaid, and Medicare patients at the main than at each FED (p < 0.001). Insurance types were significantly different between each of the three FEDs and the main ED (p < 0.001) and between each of the three FEDs (p < 0.001).


CONCLUSIONS
There were less privately insured patients and more self-pay, Medicaid, and Medicare patients at the main ED compared to the FEDs. Privately insured patients decreased at both the FEDs and main ED during the study. Insurance distribution was significantly different between the main ED, and three FEDs, and between individual FEDs.
Department of Emergency Medicine, Cleveland Clinic Akron General, Akron, Ohio; Northeastern Ohio Medical University (NEOMED), Rootstown, Ohio.
Erin L
EL
Simon
Department of Emergency Medicine, Cleveland Clinic Akron General, Akron, Ohio.
Gregory
G
Griffin
Department of Emergency Medicine, Cleveland Clinic Akron General, Akron, Ohio.
Kseniya
K
Orlik
Northeastern Ohio Medical University (NEOMED), Rootstown, Ohio.
Zhenyu
Z
Jia
Department of Emergency Medicine, Cleveland Clinic Akron General, Akron, Ohio.
Dave
D
Hayslip
Northeastern Ohio Medical University (NEOMED), Rootstown, Ohio.
Daniel
D
Kobe
Department of Emergency Medicine, Cleveland Clinic Akron General, Akron, Ohio; Northeastern Ohio Medical University (NEOMED), Rootstown, Ohio.
Nicholas
N
Jouriles
D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data* / Q000639:trends; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D014481:United States
freestanding emergency department; insurance