Getting care: poor children and New York City hospitals

In 1984, almost 10 million visits were made to New York City hospital emergency rooms and outpatient departments. Of these, nearly one-quarter were made by children. Almost nine out of ten children using hospital emergency rooms and outpatient departments were either poor or uninsured. Nearly 70 percent of emergency room visits by Medicaid-covered children in 1984 were made to voluntary hospitals, as compared with less than 40 percent of uninsured visits. Medicaid patients -- poor but uninsured -- are less likely than uninsured patients to visit the emergency room for non-urgent care. For example, in 1984, 35 percent of uninsured medical and surgical after-care visits were made to the emergency room, as compared with 13 percent of Medicaid-covered visits. The availability of primary care physicians in a neighborhood reduces the rate of outpatient department use by children covered by Medicaid, but has no affect on the utilization rates of uninsured children. Access to routine health care by uninsured children is limited by the number of municipal hospital sites, both because children seek care within their home community. More details from the study of poor children and New York City hospitals follow. Data sources and statistical methods are described in an appendix to this report.