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Getting care: poor children and New York City hospitals
Insights
Nearly 25% of 10 million NYC hospital visits in 1984 were by children, mostly poor or uninsured. Medicaid patients used voluntary hospitals more and emergency rooms less for non-urgent care than uninsured children.
Area of Science:
- Public Health
- Health Services Research
- Pediatric Healthcare Access
Background:
- In 1984, New York City hospitals recorded nearly 10 million emergency room and outpatient visits.
- Children accounted for approximately one-quarter of these visits, with the majority being poor or uninsured.
Purpose of the Study:
- To analyze healthcare utilization patterns among children in New York City hospitals.
- To compare the use of emergency rooms and outpatient departments by poor, uninsured, and Medicaid-covered children.
- To investigate factors influencing healthcare access for vulnerable pediatric populations.
Main Methods:
- Analysis of hospital visit data from New York City in 1984.
- Comparison of utilization rates based on insurance status (Medicaid vs. uninsured) and socioeconomic status.
- Examination of the impact of primary care physician availability and hospital site locations on healthcare access.
Main Results:
- Almost 90% of children visiting emergency rooms or outpatient departments were poor or uninsured.
- Medicaid-covered children were more likely to visit voluntary hospitals than uninsured children.
- Medicaid patients were less likely than uninsured patients to use emergency rooms for non-urgent care.
- Primary care physician availability reduced outpatient use by Medicaid children but not uninsured children.
- Uninsured children's access to routine care was limited by the number of municipal hospital sites.
Conclusions:
- Healthcare access and utilization differ significantly between poor, uninsured, and Medicaid-covered children in urban settings.
- Insurance status and socioeconomic factors influence the choice of healthcare facilities and the urgency of care sought.
- The availability of primary care and proximity of healthcare facilities are critical determinants of access for vulnerable pediatric populations.
Abstract:
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.