- Uninsured adult patients and those covered by Medicaid were more likely to be transferred to another hospital than privately insured patients when seeking treatment for three common pulmonary medical conditions, according to a report in JAMA Internal Medicine.
- The study also found that uninsured patients were more likely to be discharged than privately insured patients. Medicaid patients, however, seemed to have the same odds.
- The study also examined whether hospital ownership plays a role in patient care and found that for-profit hospitals were more likely to transfer uninsured patients.
This latest study seeks to analyze whether insurance status plays a role in treatment, but attempts to take into account whether a hospital is capable of treating a higher-acuity patient before transfer. The researchers say this type of measure was not included in previous research on insurance status and care, and in those studies the transfers may have reflected a need for a higher level of care.
Still, a disparity was evident.
"More than 3 decades after the passage of the EMTALA, we found differences in access to hospital care based on patient insurance status, suggesting a unique modern-day barrier to hospitalization for common medical conditions," the report stated.
The study authors called on policymakers to "broaden the scope of hospital quality, payment, and certification initiatives to reduce these disparities and improve access to hospital-based care."
Researchers examined more than 30 million emergency room visits to 953 hospitals in 2015, using data contained in the National Emergency Department Sample, an all-payer database. From there, they decided to narrow the research down to those treated for three pulmonary related medical conditions: asthma, COPD and pneumonia.
In 2015, about 215,000 patients visited ERs for these conditions, after excluding visits for various reasons including those younger than 18, death and whether a patient left against medical advice.
To account for necessary transfers, the researchers "restricted the data set to hospitals with evidence of advanced critical care capabilities for pulmonary care," which left them with the sample size of about 215,000 patients treated at 160 hospitals with intensive care capabilities for the pulmonary conditions measured.