Online Program

Chronic Condition Predictors of Emergency Room Expenditures Among Uninsured People Aged 45-64

Tuesday, November 3, 2015

Julie Summey, M.A.T. Ed.D., Department of Public Health Sciences, Clemson University, Clemson, SC

Chronic health conditions among the uninsured aged 45-64 are likely to cause high costs for Medicare when these individuals turn 65. Proper prevention and management of these chronic conditions among middle-aged uninsured people constitutes not only an issue of equity but also of efficiency. The purpose of this study was to explore which chronic conditions are associated with emergency room expenditures among uninsured people aged 45-64 living in the U.S.


We used the MEPS 2012 household component data to estimate the association between specific chronic conditions and ER expenditure (N=1102). To deal with the left-censored distribution of the dependent variable “total ER expenditure,” we used a Tobit regression model to determine which chronic conditions predict ER expenditures among uninsured people aged 45-64. Independent variables included smoking, cardiovascular disease, diabetes, cancer, pneumonia, asthma, mental disorders, back problems, skin problems, and kidney disease. We controlled for the sociodemographic confounders gender, race/ethnicity, education level, geographic region, household income and marital status.


Cardiovascular disease (β=1453.237, p =.017), diabetes (β=2072.317, p =.007), and back problems (β=3215.644, p =.000) were found to be significant contributors to ER expenditure. Kidney disease was marginally significant (β=2805.303, p =.060).


ER expenditure signals an inefficient use of health care resources, and ER expenditure beyond age 45 among the uninsured could predict high cost for Medicare. Public health stakeholders should focus on controlling cardiovascular disease, diabetes, and back problems among the uninsured as these conditions are most significant predictors of ER use among the uninsured aged 45-64.

Learning Areas:

Provision of health care to the public

Learning Objectives:
Identify chronic conditions that are associated with emergency room expenditures among uninsured people aged 45-64 living in the U.S.

Keyword(s): Economic Analysis, Underserved Populations

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a Ph.D. student in Applied Health Research and Evaluation. This year, I have been studying healthcare economics and have been a research assistant for another project focusing on the uninsured in SC. This experience and interest led to me to further study predictors of ER expenditures among the uninsured nationwide.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.