Health Care, Access, Insurance
Emergency Department Utilization in Adults with a Usual Source of Care
(School of Public Health (UMD) Health Services Administration Doctoral Student)
Akre, Ellesse-Roselee (UMD SPH Health Services Administration), Franzini, Luisa (UMD SPH Health Services Administration)
Objective: Despite expanding Medicaid, in some states, and increasing health insurance coverage across the nation emergency department (ED) utilization is steadily increasing. Studies identified limited accessibility, poor communication with and dissatisfaction with providers as factors contributing to ED use. Approach: This study examined the impact access to, confidence in and satisfaction with a health care provider has on ED utilization in adults between the ages of 18 and 64 who have a Usual Source of Care (USC). Methods: Secondary data analysis using the 2014 Medical Expenditure Panel (MEPS) data was conducted. The sample population consisted of 12,684 respondents representing 146,845,336 noninstitutionalized civilians living in the United States. Binary regressions and multivariate logistic regressions analyses were used to demonstrate the relationships between ED and independent variables. Variables significantly related to ED use were included in the final models. Odds ratios (OR) were reported for ease of interpretation. Models were adjusted for national representation. Results: Increased utilization of the ED was associated with gender, race, sex, education and race (p<.001). There was not sufficient evidence that variables related to satisfaction with a patient's care provider were associated with ED use. Respondents who reported having difficulty contacting their USC by had 24% increased a likelihood of using ED in 2014 (p<.05). Variable related to confidence in respondents USC had a decreased likelihood of ED utilization (p<.05). Public Health Significance: One aspect of access and confidence in your USC were associated with decreased utilization of the ED. Efforts to reduce ED utilization should focus on patient and physician interaction. Merely expanding health care coverage is not enough; it essential to explore mechanisms that will ensure patients seek care at the appropriate facilities in order to decrease health care expenditures.