Are publicly insured children less likely to be admitted to hospital than the privately insured (and does it matter)?

•ERs are less likely to admit publicly insured children than privately insured ones.•The gap grows during high flu weeks, when hospital beds are in high demand.•This pattern persists even after controlling for detailed diagnostic groups and hospital.•But lower admission rates have no impact on repeat ER visits or future admissions.•Perhaps too many children are being admitted most of the time, regardless of insurer.

There is continuing controversy about the extent to which publicly insured children are treated differently than privately insured children, and whether differences in treatment matter. We show that on average, hospitals are less likely to admit publicly insured children than privately insured children who present at the ER and the gap grows during high flu weeks, when hospital beds are in high demand. This pattern is present even after controlling for detailed diagnostic categories and hospital fixed effects, but does not appear to have any effect on measurable health outcomes such as repeat ER visits and future hospitalizations. Hence, our results raise the possibility that instead of too few publicly insured children being admitted during high flu weeks, there are too many publicly and privately insured children being admitted most of the time.