Hospital admissions through the emergency department: Does insurance status matter?

PURPOSE: To assess the effect of insurance status on the probability of adm ission and subsequent health status of patients presenting to emergency dep artments. SUBJECTS AND METHODS: We performed a prospective cohort study of patients w ith common medical problems at five urban, academic hospital emergency depa rtments in Boston and Cambridge, Massachusetts. The outcome measure for the study was admission to the hospital from the emergency depart men; and fun ctional health status at baseline and follow-up. RESULTS: During a 1-month period, 2,562 patients younger than 65 years of a ge presented with either abdominal pain (52%), chest pain (19%) or shortnes s of breath (29%). Of the 1,368 patients eligible for questionnaire, 1,162 (85%) completed baseline questionnaires, and of these, 964 (83%) completed telephone follow-up interviews 10 days later. Fifteen percent of patients w ere uninsured and 34% were admitted to the hospital from the emergency depa rtment. Uninsured patients were significantly less likely than insured pati ents to be admitted, both when adjusting for urgency, chief complaint, age, gender and hospital (odds ratio = 0.5, 95% confidence interval 0.3 to 0.7) , and when additionally adjusting for comorbid conditions, lack of a regula r physician, income, employment status, education and race (odds ratio = 0. 4, 95% confidence interval 0.2 to 0.8). However, there were no differences in adjusted functional health status between admitted and nonadmitted patie nts by insurance status, either at baseline or at 10-day follow-up. CONCLUSIONS: Uninsured patients with one of three common chief complaints a ppear to be less frequently admitted to the hospital than are insured patie nts, although health status does not appear to be affected. Whether these r esults reflect underutilization among uninsured patients or overutilization among insured patients remains to be determined. Am I Med. 1998;105:506-51 2. (C) 1998 by Excerpta Medica, Inc.