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Poor kids are treated differently in emergency rooms, study says

Hospital Beds
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Hospitals seem to prefer kids with private insurance over those with public insurance, and it shows in how they're treated.

That's according to a recent paper by Princeton economists Diane Alexander and Janet Currie.

The researchers looked at hospital billings from New Jersey, for kids who visited any emergency room between 2006 and 2012.

They found that during emergency room visits, children on public insurance – largely Medicaid and the Children's Health Insurance Program (CHIP) – are less likely than kids on private insurance to be admitted to the hospital. According to The Washington Post:

They found that between similar children who show up at the same emergency room at the same time with flu symptoms, the one on public insurance was about 10 percent less likely to be hospitalized. For other kinds of health problems — asthma, dehydration and appendicitis are relatively common — children on public insurance were about 5 percent less likely to be hospitalized.

The disparity was even greater during peak flu weeks, when hospitals had fewer available beds. Kids between ages 2 and 10 with public insurance were about 20% less likely to be admitted during these times.

“When the hospital has the capacity, then it will take both private and public patients. However, when beds are in short supply, hospitals have a clear reason to prefer privately insured patients,” the paper says.

So why are hospitals more hesitant to admit kids with Medicaid-CHIP? Like many of the disparities State of Opportunity discusses, it comes down to money. According to The Washington Post:

Medicaid is famously stingy with its reimbursements, and as a result, many doctors are reluctant to accept Medicaid patients. It seems hospitals take the same approach. The billing data show that when publicly insured children do end up hospitalized, they rack up more expensive charges than privately insured children. This suggests that publicly insured children have to be sicker before they can get a hospital bed. Yet, despite requiring more services, publicly insured children tend to be less lucrative for hospitals; they get much more money from children with private insurance.

This is not the first study to find gaps in access to medical treatment for kids with public insurance.

A 2011 study in The New England Journal of Medicine found kids with Medicaid are far more likely than those with private insurance to be turned away by medical specialists or be made to wait more than a month for an appointment.

From January to May 2010, researchers posed as the parents of sick or injured children, and called 273 specialty practices in Cook County, Illinois to schedule appointments. If asked, they said primary care doctors or emergency departments had referred them. According to The New York Times:

Sixty-six percent of those who mentioned Medicaid-CHIP were denied appointments, compared with 11 percent who said they had private insurance. In 89 clinics that accepted both kinds of patients, the waiting time for callers who said they had Medicaid was an average of 22 days longer.

But none of the children in the Princeton economists' study was necessarily turned away. Prior to 1986, hospitals could refuse treatment if a patient was unable to pay for it. Now, they pretty much have to treat anyone who comes in to the emergency room.

But for certain cases, hospitals were more likely to set aside a bed for kids with private insurance.

More than 40% of kids in the U.S. are on public health insurance. And since 1989, the number of uninsured children has dropped from 15% to 6%, according to The Washington Post.

This is great news. It means that low-income kids are more likely to get the medical care they need. But it becomes less comforting when studies such as these reveal the gaps that still exist despite the government's efforts.

Paulette is a blogger for Michigan Radio's State of Opportunity project, which looks at kids from low-income families and what it takes to get them ahead. She previously interned as a reporter in the Michigan Radio newsroom.
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