EMERGENCY DEPARTMENT THROUGHPUT AS A HEALTH SYSTEM PERFORMANCE OUTCOME: STATE-LEVEL ASSOCIATIONS WITH INSURANCE COVERAGE, REGIONAL PRICES, INCOME, AND HOSPITAL CAPACITY
Author(s)
Wenbo Tang, Undergraduate.
Hunan University, Changsha, China.
Hunan University, Changsha, China.
OBJECTIVES: Emergency department (ED) throughput is often treated as a hospital operations issue, yet prolonged ED time may also reflect health system performance and regional socioeconomic conditions. This study examined whether state-level ED throughput in the United States is associated with insurance coverage, income, regional prices, and hospital capacity.
METHODS: I conducted an ecological cross-sectional analysis of all 50 U.S. states and the District of Columbia. ED throughput was measured using CMS OP18a and OP18b indicators. Covariates included uninsured rate and per capita income from the American Community Survey, regional price parity from the Bureau of Economic Analysis, and hospital beds per 100,000 population from KFF. Ordinary least squares models with robust standard errors were estimated. The primary model regressed OP18a on uninsured rate, per capita income per $10,000, centered 2024 regional price parity, and beds per 100,000 population. Sensitivity analyses used OP18b and HEOR-derived income-to-price and cost-adjusted bed capacity indicators.
RESULTS: The sample included 51 state-level observations. Mean OP18a was 163.24 minutes (114.00-323.00), and mean OP18b was 157.33 minutes (110.00-310.00). Mean uninsured rate was 7.54%, mean per capita income was $44,770.39, mean regional price parity was 97.22, and mean bed capacity was 248.10 per 100,000 population. In the primary model, covariates explained 42.7% of OP18a variation. Higher per capita income was associated with longer OP18a time (β=33.14 minutes per $10,000; robust SE=15.25; p=0.030). Other primary covariates were not independently associated with OP18a. In the HEOR-adjusted specification, income-to-price ratio remained positively associated with OP18a (β=40.73; robust SE=16.44; p=0.013).
CONCLUSIONS: ED throughput varies substantially across U.S. states and is not explained by insurance coverage, regional prices, or bed supply alone. Income-related associations suggest that ED performance may reflect broader service utilization and regional system complexity. These ecological findings are descriptive and support future HEOR studies incorporating hospital-level utilization, payer mix, workforce, and inpatient flow measures.
METHODS: I conducted an ecological cross-sectional analysis of all 50 U.S. states and the District of Columbia. ED throughput was measured using CMS OP18a and OP18b indicators. Covariates included uninsured rate and per capita income from the American Community Survey, regional price parity from the Bureau of Economic Analysis, and hospital beds per 100,000 population from KFF. Ordinary least squares models with robust standard errors were estimated. The primary model regressed OP18a on uninsured rate, per capita income per $10,000, centered 2024 regional price parity, and beds per 100,000 population. Sensitivity analyses used OP18b and HEOR-derived income-to-price and cost-adjusted bed capacity indicators.
RESULTS: The sample included 51 state-level observations. Mean OP18a was 163.24 minutes (114.00-323.00), and mean OP18b was 157.33 minutes (110.00-310.00). Mean uninsured rate was 7.54%, mean per capita income was $44,770.39, mean regional price parity was 97.22, and mean bed capacity was 248.10 per 100,000 population. In the primary model, covariates explained 42.7% of OP18a variation. Higher per capita income was associated with longer OP18a time (β=33.14 minutes per $10,000; robust SE=15.25; p=0.030). Other primary covariates were not independently associated with OP18a. In the HEOR-adjusted specification, income-to-price ratio remained positively associated with OP18a (β=40.73; robust SE=16.44; p=0.013).
CONCLUSIONS: ED throughput varies substantially across U.S. states and is not explained by insurance coverage, regional prices, or bed supply alone. Income-related associations suggest that ED performance may reflect broader service utilization and regional system complexity. These ecological findings are descriptive and support future HEOR studies incorporating hospital-level utilization, payer mix, workforce, and inpatient flow measures.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HSD102
Topic
Health Policy & Regulatory, Health Service Delivery & Process of Care
Disease
No Additional Disease & Conditions/Specialized Treatment Areas