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Too Little or Too Much: Pediatric Admission Disparities Studied

PRINCETON, NJ – Children with public insurance such as Medicaid were less likely to be admitted to the hospital through the emergency department (ED) than those with private insurance, even if their symptoms were the same, according to a new study.

The report, published in the journal Economics and Human Biology, notes that is especially the case if hospital beds are scarce.

The unexpected outcome of the Princeton University-led research, however, is that the disparity doesn’t appear to have much effect on outcomes.

“In the end, I think we came to kind of a surprising conclusion that maybe the problem isn't that too few publicly insured children are being hospitalized,” said Princeton health economist Janet Currie, PhD. “Maybe the problem is that too many privately insured children are being hospitalized when they don’t really need it.”

Those inferences were reached after analysis of tens of thousands of children who presented to New Jersey EDs between 2006 and 2012.

Researchers sought to answer the question of whether EDs and hospitals treat privately insured pediatric patients differently than those covered by Medicaid and the State Children's Health Insurance Program (SCHIP), especially since payment generally is lower.

To determine that, they examined records on all children between the ages of 3 months and 13 years who came to a New Jersey ED over seven years. Both admissions and bed availability were tracked.

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Results indicate that publicly insured children were less likely to be admitted to the hospital overall – and even more so when hospital beds were scarce.

“That sounds kind of sinister, but we see absolutely no evidence it results in any increased return trips to the emergency room or that those who return are sicker,” Currie said. “As far as we can see, yes, people are being turned away because they have public health insurance, but there’s no health consequence.”

Currie pointed out that unnecessary hospital admissions raise the risk of hospital-acquired infections and other complications, the cost of hospitalization, as well as the time children are out of school.

In essence, she said, the problem is this: “There are people who are getting things they don’t need and then there are people who do need treatments but aren’t getting them. So, in some sense, the procedures aren’t being matched properly to the patients. If you kept the same amount of care and allocated it better, you could have better health outcomes for the same overall cost.”