Mental Health Emergencies; A national study finds children without insurance who seek treatment for a mental health disorder in the emergency department (ED) are more likely than those with private insurance to be transferred to another hospital. The study, conducted by researchers at UC Davis Children’s Hospital and the UC Davis Department of Psychiatry; so show differences in the decisions to admit or transfer children with mental health emergencies based on the patients’ insurance type.
Disorders and schizophrenia
For the study, the researchers asses a national sample of 9,081 acute mental health events; so among children in EDs. They look at the patient’s insurance coverage; also a hospital’s decision to admit or transfer patients with a mental health disorder. “They found that children without insurance are 3.3 times more likely to be transfer than those with private insurance,” said Jamie Kissee Mouzoon; so research manager for the Pediatric Telemedicine Program at UC Davis Children’s Hospital and first author on the study. “The rate was even higher for patients presenting with bipolar disorder, attention deficit and conduct disorders and schizophrenia.”
This is a cross-sectional study of pediatric mental health ED admission; also 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; so who were either admit locally or transfer to another hospital were include. Multivariable logistic regression models were use to adjust for confounders.
Mental health emergencies
The study shows there may be gaps in providing equitable and quality care to pediatric patients with mental health emergencies base on their insurance coverage. Transferring a child creates additional burdens for the patient, family and health care system as a whole. It can add to overcrowding in busy emergency departments, higher costs of care and higher out-of-pocket costs for the family.
According to James Marcin, senior author on the study; so there are regulations in place to prevent EDs from making treatment decisions base on the patients’ insurance. Transferring a patient for any other reason than clinical necessity should be avoided. “Unfortunately, the financial incentives are sometimes hard to ignore and can be even unconscious,” Marcin said.
“What we have found in this study is consistent with other research that demonstrates that patients without health insurance are more likely to get transfer from clinic to clinic or hospital to hospital.” Marcin also is director for the UC Davis Center for Health and Technology and leads the telemedicine program at UC Davis Health. He is looking into ways that tele medicine video visits deliver to the children who seek care in remote EDs might be a solution to the tendency to transfer the patient to another hospital.