By James W. Moser, PhD, Kimberly E. Applegate, MD, MS
Journal of the American College of Radiology, January 2012

Compared with non-Medicaid insured ED patients, uninsured ED patients were less likely to get any imaging services and to get lower value imaging RVUs (relative value units), results that held for nearly all modalities. Similar results regarding the number and value of imaging services, as well as health status, were found for Medicaid patients.

Even after controlling for health status and other measurable factors, the average number of imaging tests received by uninsured ED patients was ≥8% lower than that for non-Medicaid insured ED patients. The deficit for Medicaid ED patients was even greater, at about 10%. Uninsured ED patients and Medicaid ED patients also received fewer imaging-related RVUs per visit than non-Medicaid insured ED patients: 13% and 19%, respectively. These differences amplify the potentially serious health implications for persons lacking conventional health insurance. As the number of uninsured Americans continues to rise, the use of ED services will also rise.

The differences in imaging RVUs by insurance group stemmed from a bias toward lower valued imaging modalities for persons lacking coverage compared with insurance persons. Medicaid patients, perhaps underinsured, also received lower valued imaging and less imaging compared with insured patients. Other studies have found that the uninsured are less likely to get timely medical care and consequently are sicker upon being admitted to the hospital.

http://www.jacr.org/article/S1546-1440(11)00445-5/fulltext

Comment:

By Don McCanne, MD

Fully predictable. Uninsured and Medicaid emergency department patients receive fewer imaging tests, and when they do receive them, they are more likely to be lower valued tests. Under the Affordable Care Act, many individuals will remain uninsured and many more will be enrolled in Medicaid. Thus this is a problem that is not going away.

We can do better than this.

Imaging and Insurance: Do the Uninsured Get Less Imaging in Emergency Departments?

By James W. Moser, PhD, Kimberly E. Applegate, MD, MS
Journal of the American College of Radiology, January 2012
Compared with non-Medicaid insured ED patients, uninsured ED patients were less likely to get any imaging services and to get lower value imaging RVUs (relative value units), results that held for nearly all modalities. Similar results regarding the number and value of imaging services, as well as health status, were found for Medicaid patients.
Even after controlling for health status and other measurable factors, the average number of imaging tests received by uninsured ED patients was ≥8% lower than that for non-Medicaid insured ED patients. The deficit for Medicaid ED patients was even greater, at about 10%. Uninsured ED patients and Medicaid ED patients also received fewer imaging-related RVUs per visit than non-Medicaid insured ED patients: 13% and 19%, respectively. These differences amplify the potentially serious health implications for persons lacking conventional health insurance. As the number of uninsured Americans continues to rise, the use of ED services will also rise.
The differences in imaging RVUs by insurance group stemmed from a bias toward lower valued imaging modalities for persons lacking coverage compared with insurance persons. Medicaid patients, perhaps underinsured, also received lower valued imaging and less imaging compared with insured patients. Other studies have found that the uninsured are less likely to get timely medical care and consequently are sicker upon being admitted to the hospital.
http://www.jacr.org/article/S1546-1440(11)00445-5/fulltext

Fully predictable. Uninsured and Medicaid emergency department patients receive fewer imaging tests, and when they do receive them, they are more likely to be lower valued tests. Under the Affordable Care Act, many individuals will remain uninsured and many more will be enrolled in Medicaid. Thus this is a problem that is not going away.
We can do better than this.