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Kids with no insurance transferred more often

September 26, 2016

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Uninsured = OTD?
Kids with no insurance had almost 4 times the odds of being transferred to another hospital than being admitted at the initial hospital.  Is it possible that uninsured kids are sicker and need transfer more often?  Maybe…but 4 times more often?  I work at both a small community PED twice a month and at a tertiary care center the rest of the time.  Maybe I’m naive, but insurance coverage has nothing to do with this decision.  It’s a medical decision. At least it should be.  Happily, my institution backs me on this 100%.

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Transfer patients who need to be transferred.  Admit patients who need to be admitted – to the appropriate hospital.  But don’t let insurance status factor into your thinking at all.  And if administrators are pressing you on this, it may be time to look for new place to work!

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Ann Emerg Med. 2016 Aug 20. pii: S0196-0644(16)30262-1. doi: 10.1016/j.annemergmed.2016.06.007. [Epub ahead of print]

The Association Between Insurance and Transfer of Noninjured Children From Emergency Departments.

Huang Y1, Natale JE2, Kissee JL2, Dayal P2, Rosenthal JL2, Marcin JP2.

Author information:

1Department of Pediatrics, University of California, Davis, Sacramento, CA. Electronic address: yruhuang@ucdavis.edu.

2Department of Pediatrics, University of California, Davis, Sacramento, CA.



Among children requiring hospital admission or transfer, we seek to determine whether insurance is associated with the decision to either admit locally or transfer to another hospital.


This cross-sectional study used Healthcare Cost and Utilization Project 2012 Nationwide Emergency Department Sample. Pediatric patients receiving care in emergency departments (EDs) who were either admitted or transferred were included. Clinical Classifications Software was used to categorize patients into noninjury diagnostic cohorts. Multivariable logistic regression models adjusting for potential confounders, including severity of illness and comorbidities, and incorporating nationally representative weights were used to determine the association between insurance and the odds of transfer relative to admission.


A total of 240,620 noninjury pediatric ED events met inclusion criteria. Patient and hospital characteristics, including older age and nonteaching hospitals, were associated with greater odds of transfer relative to admission. Patients who were uninsured or had self-pay had higher odds of transfer (odds ratio [OR] 3.84; 95% confidence interval [CI] 2.08 to 7.09) relative to admission compared with those with private insurance. Uninsured and self-pay patients also had higher odds of transfer across all 13 diagnostic categories, with ORs ranging from 2.96 to 12.00. Patients with Medicaid (OR 1.05; 95% CI 0.90 to 1.22) and other insurances (OR 1.14; 95% CI 0.87 to 1.48) had similar odds of transfer compared with patients with private insurance.


Children without insurance and those considered as having self-pay are more likely to be transferred to another hospital than to be admitted for inpatient care within the same receiving hospital compared with children with private insurance. This study reinforces ongoing concerns about disparities in the provision of pediatric ED and inpatient care.

Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

PMID: 27553479 [PubMed – as supplied by publisher]

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