Association between Insurance and the Transfer of Children with Mental Health Emergencies

Jamie L. Kissee, Yunru Huang, Parul Dayal, Peter Mackinlay Yellowlees, Ilana Sigal, James P Marcin

Research output: Contribution to journalArticle

Abstract

This study sought to investigate the association between a patient's insurance coverage and a hospital's decision to admit or transfer pediatric patients presenting to the emergency department (ED) with a mental health disorder. Methods This is a cross-sectional study of pediatric mental health ED admission and transfer events using the Healthcare Cost and Utilization Project 2014 Nationwide Emergency Department Sample. Children presenting to an ED with a primary mental health disorder who were either admitted locally or transferred to another hospital were included. Multivariable logistic regression models were used to adjust for confounders. Results Nine thousand eighty-one acute mental health ED events among children were included in the analyses. The odds of transfer relative to admission were higher for children without insurance (odds ratio, 3.30; 95% confidence interval, 1.73-6.31) compared with patients with private insurance. The odds of transfer were similar for children with Medicaid compared with children with private insurance (odds ratio, 1.23; 95% confidence interval, 0.80-1.88). Transfer rates also varied across mental health diagnostic categories. Patients without insurance had higher odds of transfer compared with those with private insurance when they presented with depressive disorder, bipolar disorder, attention-deficit/conduct disorders, and schizophrenia. Conclusions Children presenting to an ED with a mental health emergency who do not have insurance are more likely to be transferred to another hospital than to be admitted and treated locally compared with those with private insurance. Future studies are needed to determine factors that may protect patients without insurance from disparities in access to care.

Original languageEnglish (US)
JournalPediatric Emergency Care
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Insurance
Mental Health
Emergencies
Hospital Emergency Service
Odds Ratio
Mental Disorders
Logistic Models
Confidence Intervals
Pediatrics
Patient Transfer
Conduct Disorder
Insurance Coverage
Medicaid
Attention Deficit Disorder with Hyperactivity
Depressive Disorder
Bipolar Disorder
Health Care Costs
Schizophrenia
Cross-Sectional Studies

Keywords

  • emergency services
  • health services research
  • mental health

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Emergency Medicine

Cite this

Association between Insurance and the Transfer of Children with Mental Health Emergencies. / Kissee, Jamie L.; Huang, Yunru; Dayal, Parul; Yellowlees, Peter Mackinlay; Sigal, Ilana; Marcin, James P.

In: Pediatric Emergency Care, 01.01.2019.

Research output: Contribution to journalArticle

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