title: Effect of managed care on emergency department use in an uninsured population.
abstract: OBJECTIVE
  The use of managed care to decrease emergency department (ED) use has been reported with some success among Medicaid and insured populations. Our objective is to determine the effect of a managed care program (the "Program") for uninsured patients on their use of emergency, inpatient, and outpatient services.
  
  
  METHODS
  This was a retrospective, observational study with 3 groups of patients at an urban, academic medical center: uninsured patients enrolled in the Program, uninsured patients not enrolled in the Program ("Uninsured"), and commercially insured ("Commercial") patients. All patients received services at least once annually during the 5-year study duration. Administrative databases provided data on ED visits, hospital discharges, hospital days, primary care visits, and specialty care visits during the preprogram and 4 postprogram years.
  
  
  RESULTS
  There were 1,676 Program, 335 Uninsured, and 844 Commercial patients (2,855 total patients). Use of emergency, inpatient, and outpatient specialty clinics by all groups did not change significantly after program implementation. There was a modest increase in outpatient primary care use by Program members.
  
  
  CONCLUSIONS
  Implementation of a managed care program did not significantly alter ED or inpatient hospital use patterns in an uninsured, indigent population. Providing a primary care provider and health care benefits alone was insufficient to reduce ED use in this population.
authors.affiliation: Department of Emergency Medicine, University of New Mexico, Albuquerque, NM 87131-0001, USA.
authors.forename: Heemun
authors.initials: H
authors.lastname: Kwack
authors.forename: David
authors.initials: D
authors.lastname: Sklar
authors.forename: Betty
authors.initials: B
authors.lastname: Skipper
authors.forename: Arthur
authors.initials: A
authors.lastname: Kaufman
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Fingado
authors.forename: Mark
authors.initials: M
authors.lastname: Hauswald
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000328:Adult; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008329:Managed Care Programs; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D009516:New Mexico; D011320:Primary Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies