Health care access problems of medically indigent emergency department walk-in patients

To obtain health care access data on emergency department walk-in patients and to determine factors associated with delayed access to care.

Survey of stable ED walk-in patients in the triage area.

University of California Irvine Medical Center, an urban, 493-bed, noncounty, Level I teaching hospital treating 38,000 emergency patients annually.

A quota of 1,000 consecutive patients derived from a representative selection of service days was included; 94% of eligible patients agreed to participate. Patients with obstetrical problems (more than 20 weeks' gestation) were excluded.

Pretested health access survey, available in both Spanish and English, administered by investigator.

Public aid/self-pay insurance status was significantly associated with routine use of the ED for care (P less than .003), income of less than $10,000 (P less than .0002), refusal of care by health provider (P less than .001), refusal of care at an ED (P less than .03), and delay in seeking health care (P less than .0002). Income of less than $10,000 was significantly associated with routine use of the ED for care (P less than .02), and delay in seeking health care (P less than .04). Statistical analysis done using chi 2 with continuity correction and with the binomial test for comparison of two proportions.

Among stable ED walk-in patients surveyed at our facility, low-income individuals and those with public aid/self-pay insurance status were significantly more likely to use the ED as a routine source of health care, and more likely to delay in seeking needed health care, than higher income and fully insured individuals. These data should be useful to health policymakers in formulating rational, cost-effective strategies that improve access to early treatment and prevention.