The influence of insurance status on nonurgent pediatric visits to the emergency department

Objective: To compare the effects of HMOs with the effects of other types of private health insurance on nonurgent ED visits in the pediatric population. Methods: Secondary analysis of the emergency component of the 1994 National Hospital Ambulatory Medical Care Survey (NHAMCS) on patients aged 15 years or less. Variables of interest included urgency of visit, age, sex; race, ethnicity, method of payment (HMO, private insurance/nonHMO, and others), and chief complaint. A p-value of 0.01 was used as the threshold for significance to offset the effects of increases in variability and significance of p-values and narrow confidence intervals. Results: There were 6,744 observations. The overall rate of nonurgent ED visits was 58%. The rate of nonurgent visits for HMO patients was 51%, for private non-HMO insurance 56%, and for other types of payment (Medicare, Medicaid, patient paid, no charge, and other government) 60%. Chief complaints for nonurgent visits were general symptoms, EENT (ear, eyes, nose, and throat) symptoms, and dermatologic symptoms. After multivariate analysis, the odds ratio visit compared with HMO patients was 1.27, with a 95% CI = 1.07 to 1.51, after adjusting for age, sex, and chief complaint. Conclusion: Pediatric patients with private insurance were more likely to present for emergency care for nonurgent reasons when compared with HMO patients after adjusting for the above listed variables. The reasons for this disparity should be further explored.