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      The Impact of Insurance and a Usual Source of Care on Emergency Department Use in the United States

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          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.

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          Emergency department crowding, part 1--concept, causes, and moral consequences.

          John C Moskop, David Sklar, Joel Geiderman … (2009)
          Crowding is an increasingly common occurrence in hospital-based emergency departments (EDs) across the globe. This 2-article series offers an ethical and policy analysis of ED crowding. Part 1 begins with a discussion of terms used to describe this situation and proposes that the term "crowding" be preferred to "overcrowding." The article discusses definitions, measures, and causes of ED crowding and concludes that the inability to transfer emergency patients to inpatient beds and resultant boarding of admitted patients in the ED are among the root causes of ED crowding. Finally, the article identifies and describes a variety of adverse moral consequences of ED crowding, including increased risks of harm to patients, delays in providing needed care, compromised privacy and confidentiality, impaired communication, and diminished access to care. Part 2 of the series examines barriers to resolving the problem of ED crowding and strategies proposed to overcome those barriers.
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            National Hospital Ambulatory Medical Care Survey: 2007 emergency department summary.

            Richard Niska, Jianmin Xu, Farida Bhuiya (2010)
            This report presents data on U.S. emergency department (ED) visits in 2007, with statistics on hospital, patient, and visit characteristics. Data are from the 2007 National Hospital Ambulatory Medical Care Survey, which uses a national probability sample of visits to emergency departments of nonfederal general and short-stay hospitals in the United States. Sample data were weighted to produce annual national estimates. In 2007, there were about 117 million ED visits in the United States. About 25 percent of visits were covered by Medicaid or the State Children's Health Insurance Program (SCHIP). About one-fifth of ED visits by children younger than 15 years of age were to pediatric EDs. There were 121 ED visits for asthma per 10,000 children under 5 years of age. The leading injury-related cause of ED visits was unintentional falls. Two percent of visits resulted in admission to an observation unit. Electronic medical records were used in 62 percent of EDs.
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              National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary.

              C Burt, R. Jason Pitts, Jianmin Xu … (2008)
              This report presents the most current (2006) nationally representative data on visits to hospital emergency departments (ED) in the United States. Statistics are presented on selected hospital, patient, and visit characteristics. Data are from the 2006 National Hospital Ambulatory Medical Care Survey (NHAMCS), the longest continuously running nationally representative survey of hospital ED utilization. The NHAMCS collects data on visits to emergency and outpatient departments of nonfederal, short-stay, and general hospitals in the United States. Sample data are weighted to produce annual national estimates. In 2006 there were 119.2 million visits to hospital EDs, or 40.5 visits per 100 persons, continuing a long-term rise in both indices. The rate of visits per 100 persons was 36.1 for white persons, 79.9 for black persons, and 35.3 for Hispanic persons. ED occupancy (the count of patients who had arrived, but not yet discharged, transferred, or admitted) varied from 19,000 patients at 6 a.m. to 58,000 at 7 p.m. on an average day nationally. Though overall ED visits increased, the number of visits considered emergent or urgent (15.9 million) did not change significantly from 2005, nor did the number of patients arriving by ambulance (18.4 million). At 3.6 percent of visits, the patient had been seen in the same ED within the previous 72 hours. Median time to see a clinician was 31 minutes. Of all ED visits, 35.6 percent were for an injury. Patients had computerized tomography or magnetic resonance imaging at 12.1 percent of visits, blood drawn at 38.8 percent, an intravenous line started at 24.0 percent, an x ray performed at 34.9 percent, and an electrocardiogram done at 17.1 percent. Patients were admitted to the hospital at 12.8 percent of ED visits in 2006. The ED was the portal of admission for 50.2 percent of all nonobstetric admissions in the United States in 2006, an increase from 36.0 percent in 1996. Patients were admitted to an intensive care unit at 1.9 percent of visits.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Family Med
                Journal ID (iso-abbrev): Int J Family Med
                Journal ID (publisher-id): IJFM
                Title: International Journal of Family Medicine
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 2090-2042
                ISSN (Electronic): 2090-2050
                Publication date (Print): 2014
                Publication date (Electronic): 9 February 2014
                Volume: 2014
                Electronic Location Identifier: 842847
                Affiliations
                1Department of Family Medicine, Virginia Commonwealth University, 3650 Joseph Siewick Drive, No. 400 Fairfax, Richmond, VA 22033, USA
                2The Robert Graham Center, 1133 Connecticut Avenue, NW Suite 1100, Washington, DC 20036, USA
                3Department of Family Medicine, Georgetown University, 4000 Reservoir Road, NW, Washington, DC 20007, USA
                Author notes

                Academic Editor: Carolyn Chew-Graham

                Author information
                http://orcid.org/0000-0002-7865-1685
                Article
                DOI: 10.1155/2014/842847
                PMC ID: 3941574
                PubMed ID: 24678420
                SO-VID: 9fddf89f-958b-408c-8c04-2b920b395af9
                Copyright © Copyright © 2014 Winston Liaw et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 25 October 2013
                Date revision received : 19 December 2013
                Date accepted : 22 December 2013
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Medicine
                Data availability:
                ScienceOpen disciplines: Medicine

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