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

Copyright © 2014 Winston Liaw et al. 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. 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