Gender, Race and Insurance: How They Affect ER Visits

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According to a new study, it turns out that your gender, race, and even your insurance coverage can affect the level of testing and care you receive when you visit the emergency room (ER) with chest pain. In this day and age, you would not think this is an issue, but in North America it is — and it’s on the rise.

 Published in the February 2007 issue of the medical journal Academic Emergency Medicine, the study set out to determine if certain biases were at play, which would explain why black African-American men, for example, seemed to have a lower rate of care for cardiac issues in the ER than Caucasian men did. What they found was myriad discrepancies when it came to the level of care people received in an ER according to their race, gender, and insurance coverage.

 So what is at the root of the study? The researchers focused on patients who were admitted into the ER with chest pain. The problem they uncovered is that the testing required in order to determine if the chest pain was a result of coronary artery disease — a potentially lethal condition — was applied differently to each patient depending on sex, race, and insurance coverage. The researchers looked at data from the National Hospital Ambulatory Health Care Survey of Emergency Departments (NHAMCS-ED), which included information on patients, ages 30 and over, who visited the ER between 1995 and 2000. Out of 32 million visits, they focused on a sample of 7,068 patients.

 These tests include electrocardiography, chest radiography, cardiac monitoring, and oxygen saturation monitoring — all of which are noninvasive in nature and help medical professionals figure out if coronary artery disease is present in the patient. What they found is concerning: over the span of six years, the number of patients who were admitted for chest problems increased, where gender, race, and insurance coverage were all factors that dictated the level of care that the individuals received.

 Here are some of the findings that the researchers included in the study:

 — African-American men were “less likely” to receive the tests for coronary artery disease — by 25 to 30% — as compared to their non-African-American counterparts.

 — All forms of the tests mentioned above in this article have been on the decline, in terms of use, for African- American males.

 — African-American women faced a five percent lesser chance of getting an electrocardiography test than non- African-American men.

 — African-American women saw a 17% lesser chance of receiving cardiac monitoring, a 14% lesser chance of receiving oxygen saturation monitoring, and a six percent lesser chance of receiving a chest radiography test. This was in comparison to non-African-American men.

 — Insurance also factored into the chances of an individual receiving testing, where, if patients did not have commercial (private) insurance, they faced a 13% lesser chance of receiving electrocardiography. However, a whopping 82% of non-African-American men with commercial insurance received electrocardiography.

 In a country where coronary artery disease is one of the greatest killers, let’s hope that medical professionals at ERs across the U.S. will sit up and take notice. Regardless of your gender, race, or insurance coverage, you have a right to these tests. Inform your loved ones if you have a heart condition or speak to them about this issue — one day, they may be able to inform ER staff that you indeed need to be tested for coronary artery disease.

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