ArticleJAMA network open2025
Medical Debt and Entry of Satellite Freestanding Emergency Departments.
Article in JAMA network open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed.
- Medical Debt and Advanced Cancer Stage at Diagnosis.JAMA network open · 2026Article
- Freestanding emergency department compliance with consumer protections: evidence from Texas.Health affairs scholar · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
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 Panel, and data on freestanding ED openings came from the Centers for Medicare & Medicaid Services Provider of Services File. Results: The study sample included 1368 counties (48 exposed, 1320 unexposed) observed between 2011 and 2021. The baseline characteristics of exposed and unexposed counties suggested that counties exposed to freestanding EDs, on average, had a larger proportion of younger residents (≤17 years, 23.9% vs 22.8%; P = .01; ≥65 years, 15.0% vs 16.5%; P = .007), had a higher median household income ($53 284 vs $46 535; P < .001), and were more likely to be designated as urban (75.0% vs 35.1%; P < .001). Freestanding ED entry was associated with an increase of $98.20 (95% CI, $17.60-$178.81) in county-level median medical debt in collections and a 2.0-percentage point increase (95% CI, 0.7-3.2 percentage points) in the proportion of the population with medical debt in collections. Conclusions and Relevance: In this cross-sectional study, freestanding ED entry was associated with increased medical debt. Additional research is needed to better understand the mechanisms to aid the development of policies aimed at protecting patients' financial health.
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