title: Access to care issues and the role of EDs in the wake of the Affordable Care Act.
abstract: BACKGROUND
  Americans who received public insurance under the Affordable Care Act use the emergency department (ED) more frequently than before they were insured. If newly enrolled patients cannot access primary care and instead rely on the ED, they may not enjoy the full benefits of health care services.
  
  
  OBJECTIVE
  The objective of the study is to characterize reasons for ED utilization among American adults by insurance status and usual source of care.
  
  
  METHODS
  Cross-sectional analysis of adult sample respondents to the 2013 National Health Interview Survey reporting 1 or more ED visits in the preceding 12 months.
  
  
  METHODS
  Among American ED users that reported no usual source of care and who reported relying on the ED, 27.7% (95% confidence interval [CI], 23.6%-32.2%) and 35.1% (95% CI, 28.0%-43.0%) noted at least 1 issue of access and none of acuity as a reason for their last ED visit, as compared to 17.7% (95% CI, 16.3%-19.2%) among those with a stable usual source of care.
  
  
  CONCLUSIONS
  Although past research has shown that those who lack a stable usual source of care use the ED more often, this is the first population-level study to demonstrate their propensity for lack of access-based utilization. In the wake of the Affordable Care Act, EDs will need to evolve into outlets that service a wider range of health care needs rather than function in their current capacity, which is largely to address acute issues in isolation.
authors.affiliation: School of Medicine, Wayne State University, Detroit MI, USA. Electronic address: atjanke@gmail.com.
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Janke
authors.affiliation: School of Medicine, Wayne State University, Detroit MI, USA.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Brody
authors.affiliation: School of Medicine, Wayne State University, Detroit MI, USA.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Overbeek
authors.affiliation: School of Medicine, Wayne State University, Detroit MI, USA.
authors.forename: Justin C
authors.initials: JC
authors.lastname: Bedford
authors.affiliation: Department of Emergency Medicine, Wayne State University, Detroit MI, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Welch
authors.affiliation: Department of Emergency Medicine, Wayne State University, Detroit MI, USA; Cardiovascular Research Institute, Wayne State University, Detroit MI, USA.
authors.forename: Phillip D
authors.initials: PD
authors.lastname: Levy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence*; D006801:Humans; D019458:Insurance Coverage / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D011320:Primary Health Care / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult