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

Emergency Department (ED) utilization has increased dramatically over the past decade. Estimates from the National Hospital Ambulatory Medical Care Survey indicate that ED use increased 23 percent, from 89.8 million to 110 million visits 1992 and 2002. This increase in use is commonly attributed to the uninsured or individuals who lack a usual source of care. This study challenges whether these two factors are indeed associated with the likelihood of an emergency department (ED) visit. Using 2000-2001 nationally representative Community Tracking Study Household Survey data, the authors conducted descriptive and multivariate analyses to assess the independent association of usual source of care, health insurance, income and health status with the likelihood of making one or more ED visits in the previous year. The results suggest that ED users are similar to nonusers in terms of insurance status and usual source of care. Adults without a usual source of care were actually less likely to report an ED visit in the prior year compared to those whose usual source of care was a private physician. And, the uninsured were no more likely to report an ED visit than insured individuals. However, ED users are more likely to be in poor health and to experience disruptions in regular care. The authors conclude that policies designed to decrease ED use may need to focus on improving delivery of outpatient care.