NCHS Data Brief ■ No. 253 ■ June 2016 

Expected Source of Payment at Emergency Department 

Visits for Adults Aged 18–64 for the United States and in the 

Five Most Populous States, 2012 

Jill J. Ashman, Ph.D., Pinyao Rui, M.P.H., and Esther Hing, M.P.H. 

Key findings 

Data from the National 

Hospital Ambulatory 

Medical Care Survey, 2012 

● In 2012, 33% of emergency 

department (ED) visits in 

the United States made by 

adults aged 18–64 had private 

insurance as the expected 

source of payment. This 

percentage was lower for 

Illinois than for the total United 

States. 

● In 2012, 21% of ED visits 

made by adults aged 18–64 

had Medicaid as the expected 

source of payment. This 

percentage varied across the 

five most populous states, 

ranging from 12% in Texas to 

30% in New York. 

●		 In 2012, 20% of ED visits 

Visits to the emergency department (ED) by U.S. adults aged 18–64 have 

remained stable at about 20% (1,2), but ED use may vary by the expected 

source of payment. This report includes estimates for the five most populous 

states (California, Florida, Illinois, New York, and Texas). In 2012, there were 

130.9 million ED visits in the United States. The majority of these visits (63%) 

were made by adults aged 18–64 (3). Differences in ED visits made by adults 

aged 18–64 were examined by expected source of payment and state. 

Keywords: health insurance • state estimates • National Hospital Ambulatory 

Medical Care Survey 

What were the expected sources of payment for ED visits 

made by adults aged 18–64? 

●		 In 2012, one-third of ED visits made by adults aged 18–64 in the United 

States had private insurance as the expected source of payment, which 

Figure 1. Percent distribution of expected source of payment for emergency department visits 

made by adults aged 18–64: United States, 2012 

33 

21
 20

in the United States were made 

by adults aged 18–64 with no 11 insurance (self-pay, no charge, 9 

charity, or a combination of 5

these types were the only 

reported expected sources of 

payment).This percentage 

varied across the five most 

populous states, ranging from 

15% in New York to 28% in 

Texas. 

Private Medicare1,2 Medicaid1 No Workers' Unknown 

insurance1 compensation 

or other

1,2 

or blank1,2 

1

Significantly different from private (p < 0.05).
 2

Significantly different from Medicaid and no insurance (p < 0.05).
 

NOTES: Among adults aged 18–64, there were 27,500,000 emergency department visits with private insurance as the expected 


source of payment,17,608,000 with Medicaid,16,728,000 with no insurance, 8,970,000 with unknown or blank, 7,482,000 with 


Medicare, and 4,141,000 with workers’ compensation or other types of insurance. No insurance is defined as having only self-pay, 


no charge, charity, or a combination of these types as payment sources. Access data table for Figure 1 at: http://www.cdc.gov/nchs/
 

data/databriefs/db253_table.pdf#1.
 

SOURCE: NCHS, National Hospital Ambulatory Medical Care Survey, 2012.
 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
 

Centers for Disease Control and Prevention
 

National Center for Health Statistics
 
NCHS Data Brief ■ No. 253 ■ June 2016

 

 

 

was higher than all other expected sources of payment (Figure 1). 

● In 2012, one-fifth of ED visits made by adults aged 18–64 had Medicaid as the expected 

source of payment. 

●		 In 2012, one-fifth of ED visits were made by adults aged 18–64 with no insurance (self-pay, 

no charge, charity, or a combination of these types were the only reported expected sources 

of payment). 

●		 A higher percentage of ED visits made by adults aged 18–64 had either Medicaid or no 

insurance as the expected source of payment compared with workers’ compensation or other 

types of insurance. 

Did the percentage of ED visits made by adults aged 18–64 with private 

insurance as the expected source of payment vary by state? 

●		 Twenty-seven percent of ED visits made by adults aged 18–64 in Illinois had private 

insurance as the expected source of payment, which was lower than the percentage for the 

total United States (33%) (Figure 2). 

Figure 2. Percentage of emergency department visits made by adults aged 18–64 with private insurance as the expected 

source of payment, by state: United States, 2012 

35 35 35

33 

24 

27 

United States California Florida Illinois1 New York2,3 Texas 

1

Significantly different from United States (p <0.05).
 2

Significantly different from Florida (p < 0.05). .
 3

Significantly different from Illinois (p < 0.05).
 

NOTES: Among adults aged 18–64, there were 82,427,000 emergency department visits in the United States, 8,426,000 in California, 6,539,000 in Texas,
 

5,842,000 in Florida, 4,590,000 in New York, and 3,328,000 in Illinois. Access data table for Figure 2 at: http://www.cdc.gov/nchs/data/databriefs/db253_
 

table.pdf#2.
 

SOURCE: NCHS, National Hospital Ambulatory Medical Care Survey, 2012.
 

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NCHS Data Brief ■ No. 253 ■ June 2016

 

 

● The observed percentage of ED visits made by adults aged 18–64 with private insurance 

as the expected source of payment was lower in Florida (24%) than for the total United 

States (33%), but the difference was not significant. However, the difference between the 

percentage in Florida and New York (35%) was significant. 

● About 35% of ED visits made by adults aged 18–64 in New York had private insurance as 

the expected source of payment, which was higher than the percentage for Illinois (27%). 

Did the percentage of ED visits made by adults aged 18–64 with Medicaid 

as the expected source of payment vary by state? 

●		 The percentage of ED visits made by adults aged 18–64 with Medicaid as the expected 

source of payment varied across the five most populous states (Figure 3).
 

●		 In Illinois (29%) and New York (30%), the percentage of ED visits made by adults aged 

18–64 with Medicaid as the expected source of payment was higher than the percentage for 

the total United States (21%). 

●		 In Florida (15%) and Texas (12%), the percentage of ED visits made by adults aged 18–64 

with Medicaid as the expected source of payment was lower than the percentage for the total 

United States (21%). 

●		 In California (23%), Illinois (29%), and New York (30%), the percentage of ED visits made 

by adults aged 18–64 with Medicaid as the expected source of payment was higher than the 

percentage for both Florida (15%) and Texas (12%). 

Figure 3. Percentage of emergency department visits made by adults aged 18–64 with Medicaid as the expected source 

of payment, by state: United States, 2012 

30

29 

23 

21
 

15

12 

1

Significantly different from United States (p < 0.05).
 2

Significantly different from California (p < 0.05).
 3

Significantly different from Florida (p < 0.05).
 4

Significantly different from Illinois (p < 0.05). .
 5

Significantly different from New York (p < 0.05).
 

NOTES: Among adults aged 18–64, there were 82,427,000 emergency department visits in the United States, 8,426,000 in California, 6,539,000 in Texas,
 

5,842,000 in Florida, 4,590,000 in New York, and 3,328,000 in Illinois. Access data table for Figure 3 at: http://www.cdc.gov/nchs/data/databriefs/db253_
 

table.pdf#3.
 

SOURCE: NCHS, National Hospital Ambulatory Medical Care Survey, 2012.
 

Texas United States California 1,2,4,5 Florida1,2 Illinois1–3 New York1,3 

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NCHS Data Brief ■ No. 253 ■ June 2016

 

 

 

 

 

●		 In Illinois (29%), the percentage of ED visits made by adults aged 18–64 with Medicaid as 

the expected source of payment was higher than the percentage for California (23%). 

Did the percentage of ED visits made by adults aged 18–64 with no 

insurance as the expected source of payment vary by state? 

●		 The percentage of ED visits made by adults aged 18–64 with no insurance as the expected 

source of payment varied across the five most populous states (Figure 4). 

●		 In New York (15%), the percentage of ED visits made by adults aged 18–64 with no 

insurance as the expected source of payment was lower than the percentage for the total 

United States (20%), Illinois (22%), and Texas (28%). 

●		 In Texas (28%), the percentage of ED visits made by adults aged 18–64 with no insurance 

as the expected source of payment was higher than the percentage for the total United States 

(20%). 

●		 In California (17%), the percentage of ED visits made by adults aged 18–64 with no 

insurance as the expected source of payment was lower than the percentage for Texas 

(28%). 

Figure 4. Percentage of emergency department visits made by adults aged 18–64 with no insurance as the expected 

source of payment, by state: United States, 2012 

28
 

22 

21 

20 

17 

15 

United States California Florida Illinois New York1,2 Texas1,3,4 

1

Significantly different from United States (p < 0.05).
 2

Significantly different from Illinois (p < 0.05).
 3

Significantly different from California (p < 0.05). .
 4

Significantly different from New York (p < 0.05).
 

NOTES: Among adults aged 18–64, there were 82,427,000 emergency department visits in the United States, 8,426,000 in California, 6,539,000 in Texas,
 

5,842,000 in Florida, 4,590,000 in New York, and 3,328,000 in Illinois. No insurance is defined as having only self-pay, no charge, charity, or a combination of
 

these types as payment sources. Access data table for Figure 4 at: http://www.cdc.gov/nchs/data/databriefs/db253_table.pdf#4.
 

SOURCE: NCHS, National Hospital Ambulatory Medical Care Survey, 2012.
 

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NCHS Data Brief ■ No. 253 ■ June 2016

Summary 

During 2012, an estimated 130.9 million visits were made to EDs in the United States (3). ED 

visits made by adults aged 18–64 accounted for 63% of all ED visits and are the focus of this 

report. In the United States, private insurance was the expected source of payment for one-third 

of all ED visits made by adults aged 18–64, which was higher than any other expected source 

of payment. Medicaid and no insurance were next, each accounting for about one-fifth of all ED 

visits made by adults aged 18–64 in the United States. 

About 27% of ED visits made by adults aged 18–64 in Illinois had private insurance as the 

expected source of payment, which was lower than the percentage for the total United States 

(33%) and New York (35%). A similar pattern was seen in Florida, but due to a small sample size, 

a statistically significant difference was not observed. In Illinois, a higher percentage of ED visits 

were made by adults aged 18–64 with Medicaid as the expected source of payment compared 

with the percentage for the total United States. However, unlike California and New York, Illinois 

did not have a correspondingly lower percentage of ED visits made by adults aged 18–64 with 

no insurance (self-pay, no charge, charity, or a combination of these types were the only reported 

expected sources of payment). 

Use of EDs by adults aged 18–64 with Medicaid varied by state. In both California and New 

York, a higher percentage of visits to the ED were made by adults aged 18–64 with Medicaid as 

the expected source of payment compared with Florida and Texas, and a correspondingly lower 

percentage of visits to the ED were made by adults aged 18–64 with no insurance as the expected 

source of payment. 

Use of EDs by adults aged 18–64 with no insurance (self-pay, no charge, charity, or a 

combination of these types were the only reported expected sources of payment) varied by state. 

In the United States, the percentage of ED visits made by adults aged 18–64 with no insurance 

was 20%. However, in Texas, 28% of adults aged 18–64 who visited the ED had no insurance. 

Since 1987, U.S. Census Bureau estimates have shown Texas to consistently have one of the 

highest rates of uninsured residents in the country (4). In contrast, 15% of adults aged 18–64 

who visited the ED in New York had no insurance as the expected source of payment, which was 

lower than the national percentage. 

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NCHS Data Brief ■ No. 253 ■ June 2016

Definitions 

Expected source of payment for this visit: During data collection, all sources of payment were 

collected. These sources of payment were collapsed into one mutually exclusive variable 

(expected source of payment) that ranks payment sources based on the hierarchy shown below 

(5). 

Private insurance: Charges paid in-part or in-full by a private insurer (e.g., BlueCross 

BlueShield), either directly to the physician and community health center (CHC) or 

reimbursed to the patient. Charges covered under a private insurance sponsored prepaid plan 

are included. 

Medicare: Charges paid in-part or in-full by a Medicare plan. Includes payments made directly 

to the physician and CHC provider as well as payments reimbursed to the patient. Charges 

covered under a Medicare-sponsored prepaid plan are included. 

Medicaid: Charges paid in-part or in-full by a Medicaid plan. Includes payments made directly 

to the physician and CHC provider as well as payments reimbursed to the patient. Charges 

covered under a Medicaid-sponsored prepaid plan are included. 

Workers’ compensation and other: Includes programs designed to enable employees injured 

on the job to receive financial compensation, regardless of fault. For this report, “other” is also 

included in this category and includes any other source of payment not covered by the above 

categories, such as the Civilian Health and Medical Program of the Uniformed Services, state 

and local governments, private charitable organizations, and other liability insurance (e.g., 

automobile collision policy coverage). 

No insurance: Includes self-pay and no charge or charity. Self-pay is charges that are paid by 

the patient or patient’s family, which will not be reimbursed by a third party. Self-pay includes 

visits for which the patient is expected to be ultimately responsible for most of the bill, even if 

the patient never actually pays it. This does not include copayments or deductibles. No charge 

or charity is visits for which no fee is charged (e.g., charity, special research, or teaching). No 

charge or charity does not include visits paid for as part of a total package (e.g., prepaid plan 

visits, postoperative visits included in a surgical fee, and pregnancy visits included in a flat fee 

charged for the entire pregnancy). 

Unknown or blank: The primary source of payment is not known or all of the sources of 

payment listed above are left entirely blank. 

Data source and methods 

Data for this analysis are from the National Hospital Ambulatory Medical Care Survey 

(NHAMCS), an annual, nationally representative survey of nonfederal, general, and short-stay 

hospitals. NHAMCS is conducted by the National Center for Health Statistics and provides data 

on the utilization and provision of ambulatory care services in hospital EDs (5,6). NHAMCS 

uses a multistage probability design with samples of geographic primary sampling units (PSUs), 

hospitals within PSUs, and patient visits within EDs. The unweighted ED response rate was 

76.3% (75.3% weighted). Additional information on the methodology of NHAMCS has been 

described previously (5,6). 

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NCHS Data Brief ■ No. 253 ■ June 2016

The hospital location was used to generate state-level estimates. 

Differences among subgroups were evaluated with one-tailed t tests, using p < 0.05 as the level 

of statistical significance. Terms relating to differences such as ‘‘higher’’ or ‘‘lower’’ indicate 

that the difference was statistically significant. Data analyses were performed using the statistical 

packages SAS version 9.3 (SAS Institute, Cary, N.C.) and SAS-callable SUDAAN version 11.0 

(RTI International, Research Triangle Park, N.C.). 

About the authors 

Jill J. Ashman and Esther Hing are with the National Center for Health Statistics, Division of 

Health Care Statistics. Pinyao Rui is with Global Evaluation & Applied Research Solutions 

(GEARS), Inc. 

References 

1. National Center for Health Statistics. Health, United States, 2012: With special feature on 

emergency care. Hyattsville, MD. 2013. Available from: http://www.cdc.gov/nchs/data/hus/hus12. 

pdf. 

2. Gindi RM, Black LI, Cohen RA. Reasons for emergency room use among U.S. adults aged 

18–64: National Health Interview Survey, 2013 and 2014. National health statistics reports; 

no 90. Hyattsville, MD: National Center for Health Statistics. 2016. Available from: http://www. 

cdc.gov/nchs/data/nhsr/nhsr090.pdf. 

3. Hing E, Rui P. Emergency department use in the nation’s five most populous states and the 

total United States, 2012. NCHS data brief, no 252. Hyattsville, MD: National Center for Health 

Statistics. 2016. 

4. Baillargeon J, Paar D, Giordano TP, Zachariah B, Rudkin LL, Wu ZH, Raimer B. Emergency 

department usage by uninsured patients in Galveston County, Texas. Proc (Bayl Univ Med Cent) 

21(3):236–242. 2008. 

5. National Center for Health Statistics. NHAMCS micro-data file documentation. 2012. 

Available from: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/ 

NHAMCS/doc12_ed.pdf. 

6. National Center for Health Statistics. NHAMCS micro-data file. 2012. Available from: 

ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Datasets/NHAMCS/. 

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NCHS Data Brief ■ No. 253 ■ June 2016

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Suggested citation 

Ashman JJ, Rui P, Hing E. Expected source 

of payment at emergency department visits 

for adults aged 18–64 for the United States 

and in the five most populous states, 2012. 

NCHS data brief, no 253. Hyattsville, MD: 

National Center for Health Statistics. 2016. 

Copyright information 

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated. 

National Center for Health 

Statistics 

Charles J. Rothwell, M.S., M.B.A., Director 

Jennifer H. Madans, Ph.D., Associate 

Director for Science 

Division of Health Care Statistics 

Clarice Brown, M.S., Director 

Alexander Strashny, Ph.D., Associate 

Director for Science