Insurance linked to hospitals’ decision to transfer kids with 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, showed differences in the decisions to admit or transfer children with mental health emergencies based on the patients’ insurance type.

More hospital transfers for children with no insurance

For the study, the researchers assessed a national sample of 9,081 acute mental health events among children in EDs. They looked at the patient’s insurance coverage and a hospital’s decision to admit or transfer patients with a mental health disorder.

“We found that children without insurance are 3.3 times more likely to be transferred than those with private insurance,” said Jamie Kissee Mouzoon, 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.”

Inequities in mental health emergencies

The study shows there may be gaps in providing equitable and quality care to pediatric patients with mental health emergencies based 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, there are regulations in place to prevent EDs from making treatment decisions based 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 transferred 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 telemedicine – video visits delivered to the children who seek care in remote EDs – might be a solution to the tendency to transfer the patient to another hospital.

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The study published online July 1 in Pediatric Emergency Care.

Other UC Davis Health collaborators include Yunru Huang, Parul Dayal, Peter Yellowlees and Ilana Sigal.