Insurance coverage linked to access to hospital care in new JAMA study

By | April 7, 2019

Compared to privately insured patients, people who lack insurance or use Medicaid are more likely to be transferred to another hospital after receiving initial treatment in the emergency department, according to a new study published in JAMA Internal Medicine.

The uninsured are also at greater risk of being discharged from an ED and not admitted to the hospital. These findings reveal disparities in access to hospital care linked to insurance coverage, said Yale researchers.


Prior research suggests that uninsured and underinsured patients were more likely to be transferred from the ED to another hospital, especially if they needed specialized care for an emergency. But other studies, the authors said, failed to account for differences in the ability of hospitals to provide those specialized services, such as intensive care.

To explore the issue further, the Yale researchers analyzed data from a national sample of EDs for one year. They included only hospitals that offered critical care to treat three conditions commonly seen in the ED: asthma, pneumonia and chronic obstructive pulmonary disease.

The team reviewed more than 200,000 ED visits and found significant differences — linked with insurance status — in whether patients were transferred, discharged, or hospitalized.

Uninsured patients, or those on Medicare, were more likely to be transferred than patients with commercial or private insurance. The uninsured also had half the admissions rate of privately insured patients.

While the study did not examine the cause of these disparities, financial incentives for hospitals could play a role, it found. Hospitals are not reimbursed for admitting uninsured patients and they receive lower payments for Medicaid.

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As proposals to expand public health insurance are being put forward, the American Academy of Actuaries’ Health Practice Council is providing policymakers and the public with information to better understand and evaluate the proposals in a new public policy paper published in March.

“Proposals to expand health insurance coverage through public plans have important implications for consumers, taxpayers, insurers, employers, and healthcare providers, but those implications can vary considerably based on the specifics of each proposal,” said Academy Senior Health Fellow Cori Uccello, the paper’s lead author.

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