Why Are Publicly-Insured Kids Less Likely To Be Admitted To A Hospital?

Children between 2 and 10 years old who showed up at the ER with public insurance were roughly 20 percent less likely to get admitted during these peak times, according to a recent article published by the Washington Post.

Writer Jeff Guo explores the notion of differing hospital treatments based on different coverage types. He found that studies and survey prove this differential treatment to be fact, but the factors behind ‘why’ probably aren’t nearly as shocking as the end result - less effective treatment options for poorer kids. 

In America, nearly 40 percent of children are on Medicaid, 48 percent are ensured through employer plans, 6 percent are privately covered, leaving the remaining 6 percent of US children uninsured, according to a chart of Health Insurance Coverage of Children for 2015 published by the Henry J. Kaiser Foundation.

The bright side to these figures is the significant and steady reduction in the number of uninsured kids - from 15 percent to 6 percent since 1989. This is good for many reasons far beyond the obvious - more kids are covered - but evidence shows that kids with healthcare coverage are more likely to earn more income over their lifespan, and pay more taxes, according to this study published early 2015 by the National Bureau Of Economic Research which concluded that the government recoups 14 cents for each dollar that it spent on Medicaid for children by the time they reach age 28, and 56 cents on the dollar by age 60.

Though children on public health insurance are less likely than children on private insurance to be admitted to the hospital during emergency-room visits, this is not because Medicaid-covered children visit different hospitals, or are sick less than privately insured kids.

So then, why?

Since Medicaid is ‘famously stingy with its reimbursements’, hospitals are more likely to admit fewer Medicaid patients, according to a study published by the Urban Institute.

Researchers examined New Jersey hospital billing records from 2006 to 2012, which provided a complete record of children ER admissions from said time range. To sum it up, kids with Medicaid were 10 percent less likely to be hospitalized after being diagnosed with the flu, and 6 percent less for visits spurred by asthma, dehydration and appendicitis.

Though the Affordable Care Act gave states federal dollars to raise Medicaid reimbursement rates for primary care services, it was temporary. The inconveniences doctors face when seeking Medicaid reimbursements hasn’t disappeared, and doctors simply don’t want to lose money - money that pays for operating costs including physicians, staff, and equipment. 

This economical ‘tug-of-war’ over healthcare is far from over, and as data continues to be collected, presumably the answers to the problems will emerge, and streamlined efforts can work in concert for the greater good of improved health outcomes.