title: Patient Motivators for Emergency Department Utilization: A Pilot Cross-Sectional Survey of Uninsured Admitted Patients at a University Teaching Hospital.
abstract: BACKGROUND
  During the past several decades, emergency department (ED) increasing volume has proven to be a difficult challenge to address. With the advent of the Affordable Care Act, there is much speculation on the impact that health care coverage expansion will have on ED usage across the country. It is currently unclear what the effects of Medicaid expansion and a decreased number of uninsured patients will have on ED usage.
  
  
  OBJECTIVE
  We sought to identify the motivators behind ED use in patients who were admitted to a university teaching hospital in order to project the possible impact of health care reform on ED utilization.
  
  
  METHODS
  We surveyed a convenience sample of uninsured patients who presented to the ED and were subsequently admitted to the inpatient setting.
  
  
  RESULTS
  Our respondents sought care in the ED primarily because they perceived their condition to be a medical emergency. Their lack of insurance and associated costs of care resulted in delays in seeking care, in reduced access, and a limited ability to manage chronic health conditions. Thus, contributing to their admission.
  
  
  CONCLUSIONS
  Affordability will reduce financial barriers to health care insurance coverage. However, efficient and timely access to primary care is a stronger determinant of ED usage in our sample. Health insurance coverage does not guarantee improved health care access. Patients may continue to experience significant challenges in managing chronic health conditions.
authors.affiliation: Department of Emergency Medicine, UC Irvine Health, Orange, California.
authors.forename: Karla
authors.initials: K
authors.lastname: Lozano
authors.affiliation: Department of Emergency Medicine, UC Irvine Health, Orange, California.
authors.forename: Uzor C
authors.initials: UC
authors.lastname: Ogbu
authors.affiliation: Department of Medicine, UC Irvine Health, Orange, California.
authors.forename: Alpesh
authors.initials: A
authors.lastname: Amin
authors.affiliation: Department of Emergency Medicine, UC Irvine Health, Orange, California.
authors.forename: Bharath
authors.initials: B
authors.lastname: Chakravarthy
authors.affiliation: Department of Emergency Medicine, UC Irvine Health, Orange, California.
authors.forename: Craig L
authors.initials: CL
authors.lastname: Anderson
authors.affiliation: Department of Emergency Medicine, UC Irvine Health, Orange, California.
authors.forename: Shahram
authors.initials: S
authors.lastname: Lotfipour
mesh_terms: D002140:California / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005249:Fees and Charges; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006784:Hospitals, Teaching; D006785:Hospitals, University; D006801:Humans; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D010343:Patient Admission; D010865:Pilot Projects; D011320:Primary Health Care
keywords: access to care; health insurance; health reform; primary care; uninsured