title: In California, Primary Care Continuity Was Associated With Reduced Emergency Department Use And Fewer Hospitalizations.
abstract: The expansion of health insurance to millions of Americans through the Affordable Care Act has given rise to concerns about increased use of emergency department (ED) and hospital services by previously uninsured populations. Prior research has demonstrated that continuity with a regular source of primary care is associated with lower use of these services and with greater patient satisfaction. We assessed the impact of a policy to increase patients' adherence to an individual primary care provider or clinic on subsequent use of ED and hospital services in a California coverage program for previously uninsured adults called the Health Care Coverage Initiative. We found that the policy was associated with a 42 percent greater probability of adhering to primary care providers. Furthermore, patients who were always adherent had a higher probability of having no ED visits (change in probability: 2.1 percent) and no hospitalizations (change in probability: 1.7 percent), compared to those who were never adherent. Adherence to a primary care provider can reduce the use of costly care because it allows patients' care needs to be managed within the less costly primary care setting.
authors.affiliation: Nadereh Pourat (pourat@ucla.edu) is a professor in the Department of Health Policy and Management, University of California, Los Angeles (UCLA), Fielding School of Public Health, and director of research at the UCLA Center for Health Policy Research.
authors.forename: Nadereh
authors.initials: N
authors.lastname: Pourat
authors.affiliation: Anna C. Davis is a doctoral candidate in the Department of Health Policy and Management, UCLA Fielding School of Public Health.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Davis
authors.affiliation: Xiao Chen is a senior statistician at the UCLA Center for Health Policy Research.
authors.forename: Xiao
authors.initials: X
authors.lastname: Chen
authors.affiliation: Shelley Vrungos is the associate administrator at the Medical Safety Net Agency, Orange County Health Care Agency, in Santa Ana, California.
authors.forename: Shelley
authors.initials: S
authors.lastname: Vrungos
authors.affiliation: Gerald F. Kominski is a professor in the Department of Health Policy and Management at the UCLA Fielding School of Public Health and director of the UCLA Center for Health Policy Research.
authors.forename: Gerald F
authors.initials: GF
authors.lastname: Kominski
mesh_terms: D000328:Adult; D002140:California; D003266:Continuity of Patient Care / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008484:Medicaid; D017057:Medically Uninsured; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration*; D014481:United States
keywords: Continuity of Care; Health Care Reform; Previously Uninsured; Primary Care; Safety-Net