Abstract
BackgroundDuring the past several decades, emergency department (ED) increasing volume has proven to be a difficult challenge to address. With the advent of the Affordable Care Act, there is much speculation on the impact that health care coverage expansion will have on ED usage across the country. It is currently unclear what the effects of Medicaid expansion and a decreased number of uninsured patients will have on ED usage. ObjectiveWe sought to identify the motivators behind ED use in patients who were admitted to a university teaching hospital in order to project the possible impact of health care reform on ED utilization. MethodsWe surveyed a convenience sample of uninsured patients who presented to the ED and were subsequently admitted to the inpatient setting. ResultsOur respondents sought care in the ED primarily because they perceived their condition to be a medical emergency. Their lack of insurance and associated costs of care resulted in delays in seeking care, in reduced access, and a limited ability to manage chronic health conditions. Thus, contributing to their admission. ConclusionsAffordability will reduce financial barriers to health care insurance coverage. However, efficient and timely access to primary care is a stronger determinant of ED usage in our sample. Health insurance coverage does not guarantee improved health care access. Patients may continue to experience significant challenges in managing chronic health conditions.
Highlights
IntroductionRecent studies estimate that between 10% and 30% of Emergency department (ED) visits are for nonurgent conditions [3]
Emergency department (ED) utilization rates have been growing rapidly in the United States, with an estimated 117 million visits in 2010 [1]
Our study suggests that admitted uninsured patients seek care in the ED primarily because of the perceived urgency of their conditions and, less commonly, for geographic convenience, lack of health care coverage, or timely access to care
Summary
Recent studies estimate that between 10% and 30% of ED visits are for nonurgent conditions [3] Such ED utilization has been attributed to barriers in timely and efficient access to primary care, lack of transportation, cost of care, wait times, and opening hours [4,5,6,7,8,9]. Medicaid eligibility and subsidized insurance may mitigate the financial barriers that contribute to increased ED use [12]. This does not address other barriers to timely and efficient access to primary care, the community-level barriers. Cheung et al observed a direct relationship between the number of barriers faced by Medicaid recipients and RECEIVED: 16 September 2014; FINAL SUBMISSION RECEIVED: 22 March 2015; ACCEPTED: 24 March 2015
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