Privately Insured Patients Living In Areas With High Uninsured Rates Pay More for Emergency Care

Among people with private health insurance, those living in counties with high uninsured rates pay more for hospital emergency department (ED) visits than people living in counties with lower uninsured rates, new AHRQ research has found. The higher costs for ED visits in counties with high uninsured rates were not found in people who were covered by Medicare or Medicaid or who were uninsured. AHRQ researchers reviewed more than 26,000 ED visits nationwide between 2009 and 2013 to examine the validity of the so-called “spillover effect,” which maintains that the cost of treating uninsured patients could affect health care costs for those with private health insurance. They estimated that a one percentage-point increase in a county’s uninsured rate was associated with a $20 increase in an average ED payment. The analysis was based on data from AHRQ’s Medical Expenditure Panel Survey and Healthcare Cost and Utilization Project, as well as from the U.S. Census Bureau. Researchers cautioned that their findings are tentative and require further study. Their findings appear in the February 2017 issue of Health Services Research. Access the abstract.

2017 Feb 7. doi: 10.1111/1475-6773.12659. [Epub ahead of print]

Do People with Health Insurance Coverage Who Live in Areas with High Uninsurance Rates Pay More for Emergency Department Visits?

Kirby JB1, Cohen JW1.

Author information

Abstract

OBJECTIVE:

To investigate the relationship between the percent uninsured in a county and expenditures associated with the typical emergency department visit.

DATA SOURCES:

The Medical Expenditure Panel Survey linked to county-level data from the American Community Survey, the Healthcare Cost and Utilization Project, and the Area Health Resources Files.

STUDY DESIGN:

We use a nationally representative sample of emergency department visits that took place between 2009 and 2013 to estimate the association between the percent uninsured in counties and the amount paid for a typical visit. Final estimates come from a diagnosis-level fixed-effects model, with additional controls for a wide variety of visit, individual, and county characteristics.

PRINCIPAL FINDINGS:

Among those with private insurance, we find that an increase of 1 percentage point in the county uninsurance rate is associated with a $20 increase in the mean emergency department payment. No such association is observed among visits covered by other insurance types.

CONCLUSIONS:

Results provide tentative evidence that the costs associated with high uninsurance rates spill over to those with insurance, but future research needs to replicate these findings with longitudinal data and methods before drawing causal conclusions. Recent data on changes in area uninsurance rates following the ACA's insurance expansions and subsequent changes in emergency department expenditures afford a valuable opportunity to do this.