Luo Xuemei, Liu Gordon, Frush Karen, Hey Lloyd A
Center for Clinical Effectiveness, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Pediatrics. 2003 Aug;112(2):314-9. doi: 10.1542/peds.112.2.314.
Emergency department (ED) overcrowding has become a national problem. Children account for nearly 25% of overall ED visits. It has been reported that uninsured and publicly insured children are likely to visit the ED for urgent and nonurgent problems, yet it remains unclear to what extent health insurance status would influence children's overall ED utilization or ED utilization for nonurgent problems at the national level after controlling for other confounding factors. The objective of this study was to examine the effect of health insurance status on children's overall ED utilization and children's ED utilization for nonurgent problems among the general pediatric population in the United States.
Secondary analysis of the household component of the 1997 Medical Expenditure Panel Survey on 10 193 children younger than 18 years. The main outcome measures were annual overall ED utilization and ED utilization for nonurgent problems.
During 1997, 10.8% of children were uninsured for the entire year. A total of 17.5% of children were publicly insured the entire year, whereas 55.3% of children held private insurance the entire year. There were also 16.5% of children who were insured only part of the year. Without adjusting for covariates, publicly insured children were more likely to have an ED visit during the year than both privately insured children (unadjusted odds ratio [OR]: 1.26; 95% confidence interval [CI]: 1.03-1.55) and uninsured children (unadjusted OR: 1.46; 95% CI: 1.1-1.95). The difference between publicly insured and privately insured children (adjusted OR: 0.90; 95% CI: 0.70-1.16) and between publicly insured and uninsured children (adjusted OR: 1.12; 95% CI: 0.84-1.49) became insignificant after controlling for covariates. With or without adjustments for covariates, there was no significant difference in the likelihood of having an ED visit between privately insured and uninsured children. Similar to the utilization pattern of overall ED visits, publicly insured children were more likely to have a nonurgent ED visit than both privately insured (unadjusted OR: 1.86; 95% CI: 1.36-2.53) and uninsured children (unadjusted OR: 1.81; 95% CI: 1.15-2.84). Both differences disappeared after controlling for covariates. There was no significant difference in the likelihood of nonurgent ED visits between privately insured and uninsured children with or without adjustments for covariates.
Health insurance status was not associated with children's overall ED use or children's ED use for nonurgent problems at the national level. Our findings suggest that policy efforts in an attempt to relieve ED overcrowding conditions should look for measures beyond solely making changes in health insurance coverage for children.
急诊科过度拥挤已成为一个全国性问题。儿童占急诊科就诊总数的近25%。据报道，未参保和参加公共保险的儿童因紧急和非紧急问题就诊急诊科的可能性较大，但在控制其他混杂因素后，健康保险状况在全国范围内对儿童整体急诊科利用率或非紧急问题的急诊科利用率的影响程度仍不清楚。本研究的目的是探讨健康保险状况对美国普通儿科人群中儿童整体急诊科利用率以及儿童因非紧急问题的急诊科利用率的影响。
对1997年医疗支出小组调查中10193名18岁以下儿童的家庭部分进行二次分析。主要结局指标为年度整体急诊科利用率和非紧急问题的急诊科利用率。
1997年期间，10.8%的儿童全年未参保。全年共有17.5%的儿童参加公共保险，而55.3%的儿童全年持有私人保险。还有16.5%的儿童仅在一年中的部分时间参保。在未调整协变量的情况下，参加公共保险的儿童在当年进行急诊科就诊的可能性高于参加私人保险的儿童（未调整优势比[OR]：1.26；95%置信区间[CI]：1.03 - 1.55）和未参保儿童（未调整OR：1.
