Unnecessary hospital admissions have important consequences, including the risk of hospital-acquired infections and other
complications, the cost of hospitalization, and the time children are
away from school.
Hospitals are less likely to admit children covered by public
insurance such as Medicaid than privately insured children with similar
symptoms, especially when hospitals beds are scarce. But the disparity
doesn't appear to affect health outcomes, revealed Princeton
University researchers who analyzed information on tens of thousands of
children who came to New Jersey emergency rooms between 2006 and 2012.
‘Hospitals are less likely to admit children covered by public insurance than privately insured children with similar symptoms, but the disparity doesn't appear to affect health outcomes.’
"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 Princeton health economist Janet Currie. "Maybe the problem is that too many privately insured children are being hospitalized when they don't really need it."
The research was conducted by Currie, the Henry Putnam Professor of
Economics and Public Affairs, chair of the Department of Economics, and
co-director of the Center for Health and Wellbeing, and Diane Alexander,
an economist at the Federal Reserve Bank of Chicago who earned her
Ph.D. at Princeton.
titled "Are Publicly Insured Children Less Likely to Be Admitted to
Hospital Than the Privately Insured (and Does it Matter)?", was
published by the journal Economics and Human Biology
Currie, who has done extensive research on patients covered by
Medicaid, said she was drawn to the project by the challenge of
understanding whether hospitals treat people insured by Medicaid and
SCHIP (State Children's Health Insurance Program) differently than
people with private insurance. On average, hospitals receive lower
payments for treating publicly insured children than privately insured
To answer the question, Currie and Alexander examined records on all
children between the ages of three months and 13 years who came to a New
Jersey emergency room over seven years. The researchers recorded whether
the child was admitted to the hospital and whether hospital beds were
in high demand at the time because of local influenza outbreaks.
They found that publicly insured children were less likely to be
admitted to the hospital overall, even when controlled for factors such
as their diagnosis and characteristics of the hospitals. The disparity
widened when hospital beds were scarce.
"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," 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."
Why does the disparity in admission rates matter?
Anna Aizer, an associate professor of economics and public policy at
Brown University who studies health outcomes for the poor, pointed to
the finding that privately insured children may be over-treated as
"This is an important finding that is likely to spur more research
examining whether similar patterns are evident in other contexts," Aizer
said. "The results will likely have important implications for
policymakers interested in understanding and addressing both rising
health care costs and disparities in health."
Currie said the research is part of a larger project that is
examining how health care is allocated in a range of situations,
including heart attacks and cesarean sections.
"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," Currie
said. "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