Medical Debt and Entry of Satellite Freestanding Emergency Departments
Abstract
IMPORTANCE: Existing evidence suggests the growth of freestanding emergency departments (EDs) is associated with net increases in health care spending and inefficient use of emergency services; however, empirical research examining how these facilities are associated with patients' financial well-being is lacking.
OBJECTIVE: To examine whether the entry of hospital-owned satellite freestanding EDs was associated with changes in county-level medical debt in collections.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study examined the association of the entry of hospital-owned satellite freestanding EDs with medical debt between January 1, 2014, and December 31, 2021, using a difference-in-differences design comparing counties with a freestanding ED opening with counties that did not experience an opening (unexposed). The sample was restricted to counties consistently observed in the Urban Institute Credit Bureau Panel between 2011 and 2021; counties with an existing freestanding ED on or before 2014 were excluded from analysis. Data analysis was conducted between August 2024 and April 2025.
EXPOSURE: Entry of freestanding EDs between 2015 and 2021.
MAIN OUTCOMES AND MEASURES: The median medical debt in collections (among individuals with medical debt in collections) was the main outcome measure. Freestanding ED entry and medical debt outcomes were measured on the county-year level. County-by-year data on medical debt came from the Urban Institute Credit Bureau…
How strong is the evidence?
Evidence Hub reads this as a cross-sectional, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause.
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