Children without insurance who seek treatment for a mental health disorder in the emergency department are more likely than those with private insurance to be transferred to another hospital, finds new research.
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.
Researchers assessed a national sample of 9,081 acute mental health events among children in EDs, looking at the patient’s insurance coverage and a hospital’s decision to admit or transfer those with a mental health disorder.
WHAT’S THE IMPACT
Children without insurance were 3.3 times more likely to be transferred than those covered under private insurance. That rate increased even more among those with schizophrenia, bipolar disorder, and attention-deficit and conduct disorders.
There may be gaps in providing equitable and quality care to pediatric patients with mental health emergencies based on their insurance coverage, the evidence showed. Transferring a child creates additional burdens for the patient, family and health care system as a whole, the authors wrote; 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.
THE LARGER TREND
As healthcare faces a shortage of psychiatrists, the use of telehealth is growing to meet the demand for behavioral health services, particularly in rural areas.
Data from February shows that mental health reasons accounted for 31 percent of all diagnoses associated with telehealth claim lines in 2016. Mental and behavioral disorders due to psychoactive substance abuse accounted that year for the largest share, 26 percent, of claim lines with behavioral health diagnoses in telehealth.
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