Association Between Insurance and the Transfer of Children With Mental Health Emergencies

Abstract

Objectives: 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: Nineteem 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.

California Children Presenting to an Emergency Department for Mental Health Emergencies

“…Our first model analyzed patient-, hospital-, and regional-level characteristics associated with transfer in the population of initial mental health visits, which were severe enough not to be discharged, but rather warranted admission or transfer 12 …”

“…The Agency for Healthcare Research and Quality’s Clinical Classification Software was used to categorize ED mental health diagnoses. We excluded those who presented for suicide or self-inflicted harm, as these patients may be placed on mandated holds or admitted to medical wards for clearance 12 …”

“…We excluded those who presented for suicide or self-inflicted harm, as these patients may be placed on mandated holds or admitted to medical wards for clearance. 12…”

A Conceptual Framework for Optimizing the Equity of Hospital‐Based Emergency Care: The Structure of Hospital Transfer Networks

“…90 Studies examining disparities in transfers and transfer networks are mixed. Medicaid and uninsured ED patients are more likely to be transferred than privately insured patients, [91][92][93][94][95][96] though this varies by condition. 97 Descriptive research examining racial differences in the likelihood of ED transfers is mixed.…”

Family Structure and Adolescent Mental Health Service Utilization During the COVID-19 Pandemic

“…Insurance coverage is also a historic predictor of mental health service utilization [ 16 ]. Prior literature demonstrates differing treatment outcomes for adolescents with a mental health diagnosis based on insurance coverage but little data exist on the relationship between family structure and adolescent mental health service utilization in a population with similar insurance coverage [ 17 ]. Cross-sectional studies hypothesize that differing outcomes between household types could be described by a greater likelihood of employer-based health insurance in two-parent homes [ 15 ].…”