This study was flagged widely in the press recently. It's a good study, based on my cursory review, that addresses an important point:
Emergency departments are required to treat everyone who comes through the doors, but that doesn’t mean they treat everyone the same way.
Insurance coverage may play a major role in the kind of care a young patient receives, according to a study published in the most recent edition of The Journal of Pediatrics.ARRRGH!
No, no, no, no a thousand times, no. The implication here is that the ER discriminates inappropriately, either undertreating indigent children or overtreating insured children. This is not what the study says. It is, I hasten to add, a valid question, worthy of research. Bias based on socioeconomic status is a real factor in medicine, well documented, and should be looked into. But if you look at the very abstract of the study in question, it concludes: "It is unclear whether these patterns represent appropriate utilization."
The problem is that the database does not allow the researchers to account for the different characteristics of two very different populations presenting to the ER. The acuity of the uninsured children is much lower, generally (in fact, the paper affirms that the triage acuity of the uninsured group was significantly lower). In large part this is because the access to primary care for kids on Medicaid is very poor-to-nonexistent, so they substitute the ER for a PCP, visiting with very minor illnesses and well child exams at a far higher rate than privately insured kids. So you would expect a lower rate of testing in the underinsured group, because they are not the same as the privately insured kids, who have good access to pediatricians, and tend to come into the ER when they are sicker and more in need of tests.
To properly evaluate whether insurance status leads to inappropriate disparities in treatment, it would be necessary to acuity-match the two populations. The one element in the cited study that roughly does so is in the comparison of the care provided to admitted children, and in that subgroup, there was no difference in the amount of tests provided. This is not surprising, since the admitted kids are by definition the sickest and most likely to require tests and interventions. More important, if you are looking for disparities in how kids are treated, is to compare matched groups of discharged children with comparable presenting complaints. but this study, due to the limitations in the data source, cannot do that.
The study authors are remiss, in my opinion, in under-recognizing the actual acuity differences in the two groups. That they chose to headline their own study with the disparity in treatment with barely a mention of the patient-specific factors is leading and invites readers to draw conclusions which are not warranted.