Patients who had an emergency department visit and were uninsured were more frequently discharged or transferred to another hospital than patients who were privately insured, according to a study published in JAMA Internal Medicine.

Researchers examined the discharge, transfer, and admission rates of patients presenting to the emergency department with common pulmonary conditions and analyzed that rate against their health insurance status. Hospitals that had both an emergency department and intensive care capabilities and patients who were diagnosed with acute pulmonary diseases such as pneumonia, chronic obstructive pulmonary disease, and asthma were included in this study. Patient information was obtained from the 2015 National Emergency Department Sample and included age, sex, insurance status, median income of zip code of residence, diagnosis and discharge codes.

Of the 215,028 patients with acute pulmonary diseases who presented at the emergency department, 58.1% were women, and the median age was 55. In regards to patient-level outcomes, 66.5% were discharged, 1.5% were transferred to another hospital, and 32.1% were admitted. In regards to insurance status, 9.4% were uninsured, 25.5% were covered by Medicaid, and 65.1% were insured by Medicare or a private company.

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Hospital transfers occurred in 1.6% of uninsured patients, 1.3% of Medicaid covered patients, and 1.2% of privately insured patients, which meant both uninsured patients (adjusted OR, 2.41; 95% CI, 2.08-2.79) and Medicaid covered patients (adjusted OR, 1.19; 95% CI, 1.05-1.33) were more frequently transferred than privately insured patients. Hospital discharges occurred in 88.8% of uninsured patients, 80.2% of Medicaid covered patients, and 78.5% of privately insured patients, which meant uninsured patients (OR, 1.66; 95% CI, 1.57-1.76) were more likely to be discharged.

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Limitations of this study include the use of an administrative database to analyze pulmonary diagnoses, inability to control for confounding variables, and not including a truly representative sample of hospitals across the United States.

The researchers concluded they ”found differences in access to hospital care based on patient insurance status, suggesting a unique modern-day barrier to hospitalization for common medical conditions.”

Several authors report multiple associations with pharmaceutical companies. Please refer to original reference for a complete list of authors’ disclosures.


Venkatesh AK, Chou SC, Li SX, et al. Association between insurance status and access to hospital care in emergency department disposition [published online April 1, 2019]. JAMA Intern Med. doi: 10.1001/jamainternmed.2019.0037