The role of health insurance in pediatric ambulance use: are children just small adults?

Abstract

Objective: Rapidly rising healthcare costs require a thorough analysis of all the components of care. Multiple studies of adult patients with public insurance or without private insurance have shown that they are more likely than those with private insurance to use the ambulance. Multiple studies of pediatric ambulance use have been limited in generalizability because they rely on individual hospital or single statewide databases and do not specifically look at insurance. The purpose of this study was to describe pediatric ambulance use and its association with specific health insurances using the National Hospital Ambulatory Medical Survey (NHAMCS) database.Methods: NHAMCS data between 2008 to 2010 for all pediatric (age <19 years) visits were analyzed. Multivariate logistic regression was used to model ambulance utilization on insurance status while controlling for variability in demographics and severity levels.Outcomes Measured: A total of 25,215 pediatric ED visits were included representing a national sample of approximately 97,341,191 million ED visits between 2008-2010. Non-insured (9.9%) compared to privately insured (6.6%) children had significantly higher rates of ambulance use. No significant difference in ambulance utilization was noted between those with Medicaid/State Children's Health Insurance Program (SCHIP) (5.8%) versus private (6.6%) insurance. Even after controlling for demographic and severity variables the adjusted odds ratio (1.66, 95% CI 1.30-2.13, p<0.0001) identified those visits without insurance as an independent predictor of ambulance utilization. In addition, older children (12-18 years), those of black race and residing in urban areas or the Northeast also had significantly higher odds of ambulance utilization. Visits by older children, specifically those without insurance, had increased odds of ratio of ambulance utilization (1.83, CI: 1.36-2.45, p<0.0001). Conclusions:Similar to adult patients, non-uninsured versus insured visits by pediatric patients have increased ambulance utilization. Different from the adults, public the type of insurance public versus private did not affect pediatric ambulance use. Health policies that facilitate continuous insurance coverage for children may be one way to maximize resource utilization in regards to ambulance use.

What factors are associated with ambulance use for non-emergency problems in children? A systematic mapping review and qualitative synthesis

“…Several studies have found a significant link between location and non-emergency calls to the ambulance for children; in particular, urban areas were associated with more ambulance use 3 20. One study assessing the ‘appropriateness’ of ambulance use in paediatrics presenting to the emergency department (ED) identified a higher rate of what the authors termed as ‘misuse’ of ambulances for children in urban populations, and suggested that suburban parents would be less likely to call the ambulance ‘inappropriately’.…”

“…Several studies reported that Medicaid patients account for the majority of non-emergency calls to the ambulance for children; 43% of patients were insured by Medicaid, (the US federal and state programme that helps with medical costs for people with limited income) and 60% of what the authors termed as ‘unnecessary’ calls were to those without commercial insurance 21. Further studies also concluded that non-insured paediatric patients had significantly higher rates of ambulance use compared with those who were privately insured 20 23 25…”

“…21 Further studies also concluded that non-insured paediatric patients had significantly higher rates of ambulance use compared with those who were privately insured. 20 23 25…”

“…This is reported in other studies suggesting that focusing educational efforts in regard to 'appropriate' ambulance use on the adolescent population will likely reduce 'inappropriate' ambulance use in the paediatric population. 20 Additionally, further exploration at the ambulance triage and dispatch stage for children may be beneficial. 20 Fear of the consequences among parents and caregivers where children are concerned is a clear factor in increased ambulance use; however, parental concern could be a legitimate triage discriminator.…”

“…20 Additionally, further exploration at the ambulance triage and dispatch stage for children may be beneficial. 20 Fear of the consequences among parents and caregivers where children are concerned is a clear factor in increased ambulance use; however, parental concern could be a legitimate triage discriminator. Recurring messages in other literature also portray patient and carer uncertainty around urgency, the fear of harm if treatment is delayed and the value placed on clinical assessment for reassurance.…”