title: The impact of insurance and a usual source of care on emergency department use in the United States.
abstract: Background. Finding a usual source of care (USC) is difficult for certain populations. This analysis determines how insurance type and having a USC affect the settings in which patients seek care. Methods. In this cross-sectional study of the 2000-2011 Medical Expenditure Panel Surveys, we assessed the percentage of low-income persons with half or more of their ambulatory visits to the emergency department (ED). Respondents were stratified based on insurance type and presence of a USC. Results. In 2011, among Medicaid enrollees without USCs, 21.6% had half or more of their ambulatory visits to EDs compared to 8.1% for those with USCs. Among the uninsured without USCs, 24.1% went to an ED for half or more of their ambulatory visits compared to 8.8% for those with USCs in 2011. Among the privately insured without USCs, 7.8% went to an ED for half or more of their ambulatory visits compared to 5.0% for those with USCs in 2011. These differences remained in multivariate analyses. Conclusions. Those who lack USCs, particularly the uninsured and Medicaid enrollees, are more likely to rely on EDs.
authors.affiliation: Department of Family Medicine, Virginia Commonwealth University, 3650 Joseph Siewick Drive, No. 400 Fairfax, Richmond, VA 22033, USA.
authors.forename: Winston
authors.identifier: 0000-0002-7865-1685
authors.initials: W
authors.lastname: Liaw
authors.affiliation: The Robert Graham Center, 1133 Connecticut Avenue, NW Suite 1100, Washington, DC 20036, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Petterson
authors.affiliation: Department of Family Medicine, Georgetown University, 4000 Reservoir Road, NW, Washington, DC 20007, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Rabin
authors.affiliation: The Robert Graham Center, 1133 Connecticut Avenue, NW Suite 1100, Washington, DC 20036, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bazemore