Annals of Emergency Medicine
Volume 45, Issue 1 , Pages 4-12 , January 2005

Does lack of a usual source of care or health insurance increase the likelihood of an emergency department visit? Results of a national population-based study

Received 30 March 2004 ,Revised 15 June 2004 ,Accepted 26 June 2004.

References 

  1. McCaig LF, Burt CW. National Hospital Ambulatory Medical Care Survey: 2002 emergency department summary. Advance data from vital and health statistics; No 340. Hyattsville, MD: National Center for Health Statistics; 2004;
  2. Washington DL, Stevens CD, Shekelle PG, et al. Next-day care for emergency department users with nonacute conditions: a randomized, controlled trial. Ann Intern Med. 2002;137:707–714
  3. Grumbach K, Keane D, Bindman A. Primary care and public emergency department overcrowding. Am J Public Health. 1993;83:372–378
  4. Haddy RI, Schmaler ME, Epting RJ. Nonemergency emergency room use in patients with and without primary care physicians. J Fam Pract. 1987;24:389–392
  5. Cetta MG, Asplin BR, Fields WW, et al. Emergency medicine and the debate over the uninsured: a report from the task force on health care and the uninsured. Ann Emerg Med. 2000;36:243–246
  6. Measures to deal with emergency department overcrowding: American College of Emergency Physicians. Ann Emerg Med. 1990;19:944–945
  7. Billings J, Parikh N, Mijanovich T. Emergency department use in New York City: a substitute for primary care?. Issue Brief (Commonwealth Fund). 2000;Nov(433):1–11
  8. Torrens PR. Variation among emergency room populations: a comparison of four hospitals in New York City. Med Care. 1970;8:60–75
  9. Pane GA, Farner MC, Salness KA. Health care access problems of medically indigent emergency department walk-in patients. Ann Emerg Med. 1991;20:730–733
  10. Jones DS, McNagny SE, Williams MV, et al. Lack of a regular source of care among children using a public hospital emergency department. Pediatr Emerg Care. 1999;15:13–16
  11. Buesching DP, Jablonowski A, Vesta E, et al. Inappropriate emergency department visits. Ann Emerg Med. 1985;14:672–676
  12. Prince M, Worth C. A study of “inappropriate” attendances to a paediatric accident and emergency department. J Public Health Med. 1992;14:177–182
  13. O'Brien GM, Stein MD, Zierler S, et al. Use of the ED as a regular source of care: associated factors beyond lack of health insurance. Ann Emerg Med. 1997;30:286–291
  14. Stratmann WC, Ullman R. A study of consumer attitudes about health care: the role of the emergency room. Med Care. 1975;13:1033–1043
  15. Shesser R, Kirsch T, Smith J, et al. An analysis of emergency department use by patients with minor illness. Ann Emerg Med. 1991;20:743–748
  16. Baker DW, Stevens CD, Brook RH. Determinants of emergency department use by ambulatory patients at an urban public hospital. Ann Emerg Med. 1995;25:311–316
  17. Gill JM, Riley AW. Nonurgent use of hospital emergency departments: urgency from the patient's perspective. J Fam Pract. 1996;42:491–496
  18. Lucas RH, Sanford SM. An analysis of frequent users of emergency care at an urban university hospital. Ann Emerg Med. 1998;32:563–568
  19. Baker DW, Stevens CD, Brook RH. Determinants of emergency department use: are race and ethnicity important?. Ann Emerg Med. 1996;28:677–682
  20. Cunningham PJ, Clancy CM, Cohen JW, et al. The use of hospital emergency departments for nonurgent health problems: a national perspective. Med Care Res Rev. 1995;52:453–474
  21. Fryer GE, Green LA, Dovey SM, et al. Variation in the ecology of medical care. Ann Fam Med. 2003;1:81–89
  22. Mirvis DM, Chang CF, Hall CJ, et al. TennCare: health system reform for Tennessee. JAMA. 1995;274:1235–1241
  23. Hurley RE, Freund DA, Taylor DE. Gatekeeping the emergency department: impact of a Medicaid primary care case management program. Health Care Manage Rev. 1989;14:63–71
  24. Straus JH, Orr ST, Charney E. Referrals from an emergency room to primary care practices at an urban hospital. Am J Public Health. 1983;73:57–61
  25. Powers RD. Emergency department use by adult Medicaid patients after implementation of managed care. Acad Emerg Med. 2000;7:1416–1420
  26. Schoenman JA, Evans WN, Schur CL. Primary care case management for Medicaid recipients: evaluation of the Maryland Access to Care program. Inquiry. 1997;34:155–170
  27. Sisk JE, Gorman SA, Reisinger AL, et al. Evaluation of Medicaid managed care: satisfaction, access, and use. JAMA. 1996;276:50–55
  28. Miller ME, Gengler DJ. Medicaid case management: Kentucky's Patient Access and Care Program. Health Care Financ Rev. 1993;15:55–69
  29. Rutledge KM. The Oregon Health Plan: lessons learned. Healthc Financ Manage. 1997;51:48;50-41
  30. Long SH, Settle RF. An evaluation of Utah's primary care case management program for Medicaid recipients. Med Care. 1988;26:1021–1032
  31. Gadomski A, Jenkins P, Nichols M. Impact of a Medicaid primary care provider and preventive care on pediatric hospitalization. Pediatrics. 1998;101:E1
  32. Piehl MD, Clemens CJ, Joines JD. “Narrowing the gap”: decreasing emergency department use by children enrolled in the Medicaid program by improving access to primary care. Arch Pediatr Adolesc Med. 2000;154:791–795
  33. Ku L, Ellwood M, Hoag S, et al. Evolution of Medicaid managed care systems and eligibility expansions. Health Care Financ Rev. 2000;22:7–27
  34. Shactman D, Altman SH. Utilization and Overcrowding of Hospital Emergency Departments. Waltham, MA: Council on the Economic Impact of Health System Change; 2002;
  35. Kwack H, Sklar D, Skipper B, et al. Effect of managed care on emergency department use in an uninsured population. Ann Emerg Med. 2004;43:166–173
  36. Strouse R, Carlson B, Hall J. Center for Studying Health System Change: Household Survey Methodology Report 2000-01 Round Three. Washington, DC: Center for Studying Health System Change; 2003;
  37. Ware J, Kosinski M, Keller SD. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–233
  38. Center for Studying Health System Change . Community Tracking Study Household Survey: Survey Methodology Report (Round One). Washington, DC: Center for Studying Health System Change; 1998;
  39. Cunningham PJ, Kemper P. Ability to obtain medical care for the uninsured: how much does it vary across communities?. JAMA. 1998;280:921–927
  40. Kemper P, Blumenthal D, Corrigan JM, et al. The design of the community tracking study: a longitudinal study of health system change and its effects on people. Inquiry. 1996;33:195–206
  41. Cherry DK, Burt CW, Woodwell DA. National Ambulatory Medical Care Survey: 2001 summary. Advance data from vital and health statistics; No 337. Hyattsville, MD: National Center for Health Statistics; 2003;
  42. Hing E, Middleton K. National Hospital Ambulatory Medical Care Survey: 2001 outpatient department summary. Advance data from vital and health statistics; No 338. Hyattsville, MD: National Center for Health Statistics; 2003;
  43. Brogan D. Software for survey data: misuse of standard packages. In:  Armitage P,  Colton T editor. Encyclopedia of Biostatistics. Boston, MA: John Wiley and Sons; 1998;
  44. McCaig LF, Burt CW. National Hospital Ambulatory Medical Care Survey: 2001 emergency department summary. Advance data from vital and health statistics; No 335. Hyattsville, MD: National Center for Health Statistics; 2003;
  45. Kushel MB, Perry S, Bangsberg D, et al. Emergency department use among the homeless and marginally housed: results from a community-based study. Am J Public Health. 2002;92:778–784
  46. Burt M. What Will It Take to End Homelessness?. Washington, DC: Urban Institute; 2001;Available at: http://www.urban.org/UploadedPDF/end_homelessness.pdf. Accessed October 4, 2004
  47. Afilalo M, Guttman A, Colacone A, et al. Emergency department use and misuse. J Emerg Med. 1995;13:259–264
  48. Liu T, Sayre MR, Carleton SC. Emergency medical care: types, trends, and factors related to nonurgent visits. Acad Emerg Med. 1999;6:1147–1152
  49. Gill JM, Reese CL, Diamond JJ. Disagreement among health care professionals about the urgent care needs of emergency department patients. Ann Emerg Med. 1996;28:474–479
  50. Young GP, Wagner MB, Kellermann AL, et al. Ambulatory visits to hospital emergency departments: patterns and reasons for use: 24 hours in the ED Study Group. JAMA. 1996;276:460–465
  51. Lowe RA, Bindman AB. Judging who needs emergency department care: a prerequisite for policy-making. Am J Emerg Med. 1997;15:133–136
  52. Sarver JH, Cydulka RK, Baker DW. Usual source of care and nonurgent emergency department use. Acad Emerg Med. 2002;9:916–923
  53. Petersen LA, Burstin HR, O'Neil AC, et al. Nonurgent emergency department visits: the effect of having a regular doctor. Med Care. 1998;36:1249–1255
  54. Rosenblatt RA, Wright GE, Baldwin LM, et al. The effect of the doctor-patient relationship on emergency department use among the elderly. Am J Public Health. 2000;90:97–102
  55. Gill JM, Mainous AG, Nsereko M. The effect of continuity of care on emergency department use. Arch Fam Med. 2000;9:333–338
  56. Weinerman ER. Yale studies in ambulatory care. Am J Public Health. 1966;56:1037–1056
  57. Rubin MA, Bonnin MJ. Utilization of the emergency department by patients with minor complaints. J Emerg Med. 1995;13:839–842
  58. The Lewin Group . Emergency Department Overload: A Growing Crisis: The Results of the AHA Survey of Emergency Department (ED) and Hospital Capacity. Chicago, IL: American Hospital Association; 2002;
  59. Schroeder SA. The increasing use of emergency services: Why has it occurred? Is it a problem?. West J Med. 1979;130:67–69

 Author contributions: EJW, JAS, KAH, DCC, and MLC conceived the study, determined the theoretical model, and interpreted the results. EJW, JAS, and KAH designed the analyses. KAH and JAS provided statistical consultation; KAH programmed the data. EJW drafted the manuscript with contributions from JAS and KAH. All authors contributed substantially to its revision. EJW takes responsibility for the paper as a whole.The interpretations and opinions are those of the authors and may not necessarily reflect those of The Robert Wood Johnson Foundation or the University of California, San Francisco.The authors report this study did not receive any outside funding or support.Reprints not available from the authors.

PII: S0196-0644(04)01168-0

doi: 10.1016/j.annemergmed.2004.06.023

Annals of Emergency Medicine
Volume 45, Issue 1 , Pages 4-12 , January 2005