By Naomi Stark, Georgetown CCF Research Assistant

The CDC’s National Center for Health Statistics (NCHS) recently published a report on Emergency Room (ER) use among children in the U.S. using data gathered from the 2012 National Health Interview Survey (NHIS). Authors explored the relationship of child coverage type (Private, Medicaid and Uninsured) to the frequency and nature of ER visits.

In a changing healthcare landscape that includes rising costs, shifts in modalities for delivery of coverage, and reallocation of health care resources (including to preventative health measures), studying ER use offers a lens into the current state and shortcomings of outpatient care for children.

Report Highlights

The survey found that nearly one in four children covered by Medicaid visited the ER in the previous year—notably higher than the rate of uninsured children and children with private insurance (15.7% and 12.9%, respectively). Children covered by Medicaid (9.8%) were also nearly twice as likely as uninsured children (4.5%) and over three times as likely as privately-insured children (2.9%) to have visited the ER more than twice the past year.

The authors also questioned the reason of the ER visit – whether children were in the ER due to the seriousness of the problem or another factor. One third of children with Medicaid visited the ER for reasons other than a serious medical issue, as compared to one quarter of privately insured children. Reasons for these ER visits included that the doctor’s office was not open, patients had no other place to go, the emergency room was the closest provider, and that the emergency room could provide the most care. Not surprisingly, 66.9% of uninsured children that visited the ER for a reason other than the seriousness of their medical problem did so because they had no other place to go.

Survey Conclusions and Implications

The authors posit that disparities in children’s use of the ER based on insurance coverage largely reflect whether or not a child has a regular primary source of care. Stepping forward into a new era of coverage, it is imperative to monitor the association between access to insurance and inadequate utilization of care. Nobody wins when a child is sent to the ER unnecessarily. Coverage that ensures kid’s robust primary care will increase the efficiency and aptness of medical intervention, limit unnecessary expenditure of resources, and save families the cost, pain, and suffering that a trip to the ER entails.