• Erin L Simon, Gregory Griffin, Kseniya Orlik, Zhenyu Jia, Dave Hayslip, Daniel Kobe, and Nicholas Jouriles.
• Department of Emergency Medicine, Cleveland Clinic Akron General, Akron, Ohio; Northeastern Ohio Medical University (NEOMED), Rootstown, Ohio.
• J Emerg Med. 2016 Oct 1; 51 (4): 466-470.

BackgroundIt has been speculated that freestanding emergency departments (FEDs) draw more affluent, better-insured patients away from urban hospital EDs. It is believed that this leaves urban hospital-based EDs less financially secure.ObjectiveWe examined whether the distribution of patients with four types of insurance (self-pay, Medicaid, Medicare, and private) at the main ED changed after opening three affiliated FEDs, and whether the insurance type distribution was different between main ED and FEDs and between individual FEDs.MethodsA retrospective analysis of insurance status of all patients presenting to our EDs from July 2006 through August 2013. Insurance was divided into self-pay, Medicare, Medicaid, and private insurance across three time periods, which reflect the sequential opening of each FED. Insurance types for each facility were compared for individual time periods and across time periods. χ(2) was used to analyze the data.ResultsIn the three studied time frames (periods B, C, and D), there were less privately insured patients and more self-pay, Medicaid, and Medicare patients at the main than at each FED (p < 0.001). Insurance types were significantly different between each of the three FEDs and the main ED (p < 0.001) and between each of the three FEDs (p < 0.001).ConclusionsThere were less privately insured patients and more self-pay, Medicaid, and Medicare patients at the main ED compared to the FEDs. Privately insured patients decreased at both the FEDs and main ED during the study. Insurance distribution was significantly different between the main ED, and three FEDs, and between individual FEDs.Copyright © 2016 Elsevier Inc. All rights reserved.

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