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The effects of access to pediatric care and insurance coverage on emergency department utilization
William G Johnson1, Mary E Rimsza
1School of Health Administration and Policy/Department of Economics, Arizona State University, Tempe, AZ 85287-2104, USA.
Insights
Access to pediatric care significantly reduces emergency department (ED) use in children, especially for uninsured youth. Having a pediatrician is key to lower ED utilization for all children.
Area of Science:
- Pediatric Health Services Research
- Rural Health Disparities
- Healthcare Access and Utilization
Background:
- Emergency department (ED) utilization among children in rural and border communities is influenced by various socioeconomic and healthcare access factors.
- Understanding the drivers of ED use is crucial for developing targeted interventions to improve pediatric healthcare delivery.
Purpose of the Study:
- To compare emergency department (ED) utilization patterns in children with and without access to regular pediatric care in a rural, border community.
- To assess the impact of insurance coverage, ethnicity, gender, age, and geographic residence on pediatric ED use.
Main Methods:
- A 1-year study period (1999) examining children aged 0 to 19 years.
- Multivariate logistic regression models were employed to analyze the independent effects of demographic variables, insurance status, and access to pediatric care on ED utilization.
Main Results:
- Children with access to private pediatric care showed significantly lower ED utilization: 73% less likely if insured and 93% less likely if uninsured.
- Uninsured children were nearly four times more likely to use the ED compared to insured children.
- Medicaid-insured children had 54% lower ED use than privately insured children; Native American children had higher ED utilization than white, non-Hispanic children.
Conclusions:
- Establishing access to pediatric care is strongly associated with a substantial reduction in emergency department (ED) utilization for children, irrespective of insurance status.
- The positive impact of pediatric care access on decreasing ED visits is particularly pronounced among uninsured children, highlighting a critical need for accessible primary pediatric services.
Objective:
To compare children who used the emergency department (ED) in a rural, border community with those who did not over a 1-year period to estimate the effects of access to pediatric care, insurance coverage, ethnicity, gender, age, and area of residence on ED utilization.
Design:
Multivariate logit models are used to estimate the independent influence of demographic characteristics, insurance coverage, and access to pediatric care on ED utilization during 1999 by children 0 to 19 years of age.
Results:
Controlling for age, gender, ethnicity, and area of residence, children who received care from a private practice pediatric group were 73% less likely to utilize the ED if insured and 93% less likely if uninsured to use the ED than children who had not visited a pediatrician. Uninsured children were nearly 4 times more likely to use the ED than insured children. Among insured children, those covered by Medicaid were 54% less likely to use the ED than children with private insurance. Compared with white, non-Hispanic children, Asian or Hispanic children were no more likely to use the ED. Insured Native American children were more than twice as likely as white, non-Hispanic children to utilize the ED.
Conclusions:
Access to pediatric care is associated with a marked decrease in ED utilization regardless of insurance status. This decrease in ED utilization is especially large for uninsured children.
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