Changes in Emergency Department Access Between 2001 and 2005 Among General and Vulnerable Populations

Although geographic access to emergency departments (EDs) has deteriorated in only a small number of communities, these communities tended to be poor, unemployed or Hispanic, suggesting an increasing disparity in access to emergency care.

From 1995 to 2001, the number of EDs in the U.S. decreased by almost 1,000, from 4,176 to 3,195. But ED visits increased by almost 19 million, from 96.5 million to 115.3 million, suggesting EDs are facing heavier patient demand. Using census, hospital survey and location data that encompassed 28,520 zip codes with a total population size of about 272 million people, this study examined one aspect of patient access—geographic access, as measured by driving time to EDs—to determine whether it had worsened from 2001 to 2005.

Key Findings:

  • For 95 percent of Americans, driving time to an ED did not increase.
  • For the 11.4 million people who did have to drive longer, urban residents had to drive, on average, five minutes longer, while rural residents had to drive 26 minutes longer. As the authors note, for some critical care patients, “minutes matter.”
  • Vulnerable communities bore the brunt of these drive time increases: Urban and rural lower- income communities, urban neighborhoods with high unemployment and Hispanic neighborhoods had a higher relative risk of deteriorating geographic access. This is particularly concerning since previous research has shown that minority and poor communities rely on EDs more.
  • In both urban and rural areas, communities with for-profit hospitals were more likely to face increased driving time.

The authors note, geographic access is only one factor in patient access, and there are data limitations to this study regarding how drive time is calculated and how urban and rural areas are identified. However, this study raises concerns that those who depend on ED access the most are seeing the most declines. The authors call for more research on the impact of these declines on patients.