An analysis of pediatric emergency department visits indicates that implementation of the Affordable Care Act did not change the rate of these visits, and the increase in visits was independent of insurance coverage, according to a study published in Pediatrics.

In this cross-sectional, retrospective study, demographic and census data were obtained from the American Community Survey and information on emergency department visits was obtained from the Nationwide Emergency Department Sample. The Affordable Care Act became fully implemented in 2014, so that year was used as the cut-off point.

In 2013, the pediatric uninsurance rate was 7.1% and fell to 4.5% in 2016. The number of pediatric emergency department visits was 129,899,936 between 2009 and 2013 and 80,602,176 between 2014 and 2016. The rate of emergency department visits in 2009 was not significantly different from the rate in 2014 (incidence rate ratio [IRR], 0.97; 95% CI, 0.85-1.12; P =.71).

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Between 2014 and 2016, the rate of pediatric emergency department visits increased by 9.7% per year (IRR, 1.10; 95% CI, 1.04–1.16; P <.001). Regional analysis indicated the South was the only region to have a significant increase in pediatric emergency department visits after 2014 (IRR, 1.20; 95% CI, 1.12–1.28; P <.01). This increase was not dependent on insurance coverage.

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This study had several limitations: Epidemiological infectious disease trends were not incorporated; the researchers were not able to control for differences in Medicaid expansion by state; and the different types of insurance coverage were not evaluated.

The researchers concluded that “[t]here was no immediate change in pediatric emergency department visit rates in 2014. The slope of visit rates over time did increase significantly in 2014–2016 compared with previous trends. These effects were independent of insurance coverage.”


Lee M Jr, Monuteaux MC. Trends in pediatric emergency department use after the Affordable Care Act. Pediatrics. 2019;143(6). pii: e20183542.

This article originally appeared on Medical Bag