Should you let your kids' health insurance be your guide to the ER?

Gina Roberts-Grey

Are uninsured kids getting the short end of the stick in the ER?

If you have kids, then chances are you've been to - or will visit - the emergency room at least once before a child's 18th birthday. According to the federal Centers for Disease Control and Prevention, a little more than 22 percent of all trips to the ER are for children under age 18. Whether that visit is because little Johnny spiked a raging fever in the middle of the night or fell and broke an arm, you go to the emergency room expecting timely, thorough medical attention.

In the May 2012 issue of The Journal of Pediatrics, a study covering more than 84,000 visits of kids 18 and under illustrates significant health insurance-related disparities in the treatment of kids treated in the ER.

The study says 84 percent of kids who have private health insurance receive diagnostic tests and intervention, while their uninsured counterparts receive the same treatment only 73 percent of the time. Kids without insurance had a longer wait time in the ER than those with private insurance, according to the study. Sixty-one percent of uninsured children were assessed within an hour, compared with 58 percent of those with private health insurance.

An estimated 26 percent of Latino children are uninsured, compared with 10 percent of white children and 14 percent of African-American children, says Dr. Halim Hennes, professor of pediatrics and surgery at the University of Texas Southwestern Medical Center.

Why the disparity?

Doctors say the fact that many children lack a primary care physician is one reason that uninsured kids don't receive the same treatment as those with private health insurance.

Uninsured families also are less likely to establish ongoing relationships with primary care providers. This means there's no one seeing a child for wellness check-ups or for maintenance of chronic conditions, like allergies or asthma, says Dr. Keith Veselik, medical director of primary care at the Loyola University Health System in Chicago.

"If you don't have a primary doctor and need medical attention, the options are the emergency room, which cannot turn anyone away based on ability to pay, or a ‘quick care' clinic, which may not accept public aid," Veselik says.

So, many of the uninsured land in the ER by default.

Without the historical knowledge that a primary care physician has about a child's health, an emergency room doctor may not know which tests or treatments have been performed in the past. That doctor pretty much must start from scratch.

"If a patient with private insurance ends up in the emergency department, there is a good chance they were directed to go there by their doctor, specifically to have diagnostic testing performed that cannot be done in the doctor's office or because it is after hours and the situation is urgent," Veselik says.

Doctors also speculate that the parents of children with insurance are more forceful in directing the care of their children. They may ask for more testing to be done because they aren't worried about paying for it.

Closing the health care gap

Whether you have insurance or not, doctors say parents should never have to worry that a child isn't getting the best care possible.

"Almost all ER docs are paid the same, whether they see one patient or 100, and whether they order no tests or multiple tests per patient. So the ER physician has no reason to treat patients any differently based on their insurance status," Veselik says.

To ensure that your child receives the best care regardless of your insurance, Veselik suggests going in with an expectation of what should happen in the ER. That means being assertive about your child's treatment, either by asking questions about why a course of treatment is or is not being given or by bringing the child's medical history.