Hospitals Less Likely to Admit Children Insured by Medicaid, CHIP

Publically-insured children may be receiving unnecessary treatment.

Findings from a new study suggest that hospitals are less likely to admit pediatric patients who are covered by public insurance, such as Medicaid, especially when open hospital beds are limited.

Although these children are less likely to be admitted, this was not found to affect patient outcomes, according to a study published by Economics and Human Biology. However, these findings may indicate that children with private insurance are being treated unnecessarily, rather than publically-insured children not receiving care.

"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 lead researcher Janet Currie, PhD. "Maybe the problem is that too many privately insured children are being hospitalized when they don't really need it."

The researchers initiated this study to determine whether hospitals treat patients with Medicaid or CHIP insurance differently than those with private coverage. Since public programs tend to reimburse less than private insurance, it may provide hospitals with financial incentive to admit certain patients over others.

Included in the study were tens of thousands of records from pediatric patients seeking care in emergency departments in New Jersey between 2006 and 2012. The investigators evaluated whether patients were admitted, and whether hospital beds were limited.

Even when other factors were controlled for, the researchers found that pediatric patients with public insurance were less likely to be admitted, which was seen to further increase when hospital beds were in high demand, according to the study.

"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," Dr 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."

Unnecessary hospital admissions can increase the risk of hospital-acquired infections, increase costs, and cause children to miss many days of school. The researchers indicate that privately-insured children are over-treated, which may play a role in increasing healthcare costs.

"This is an important finding that is likely to spur more research examining whether similar patterns are evident in other contexts," said researcher Anna Aizer, PhD. "The results will likely have important implications for policymakers interested in understanding and addressing both rising health care costs and disparities in health."

This initial research is part of a larger study that will assess how healthcare resources are allocated in different treatment settings, such as heart attacks and cesarean sections, according to the study.

"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," Dr Currie concluded. "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."