Undocumented Patients with Access to Primary Care and Avoidable Emergency Department Visits: Evidence from a...

Area of Science:

• Health Services Research
• Public Health
• Health Equity

Background:

• Undocumented immigrants face significant barriers to healthcare access.
• Safety-net programs aim to mitigate these barriers for vulnerable populations.
• Understanding healthcare utilization patterns is crucial for program evaluation.

Purpose of the Study:

• To compare avoidable emergency department (ED) visit rates among undocumented patients in the My Health LA (MHLA) program versus other foreign-born patient groups.
• To assess the impact of a specific healthcare coverage program on ED utilization for ambulatory care sensitive conditions.

Main Methods:

• Analysis of 2016-2020 ED encounters from Los Angeles County safety-net hospitals.
• Comparison of three patient groups: MHLA undocumented, non-MHLA undocumented, and foreign-born documented patients (n=567,671).
• Mixed-effects models used to estimate odds of avoidable ED visits for ambulatory care sensitive conditions.

Main Results:

• MHLA patients showed lower likelihood of avoidable ED visits for acute conditions and non-diabetes chronic diseases compared to documented and non-MHLA undocumented patients.
• MHLA patients had a higher likelihood of ED visits related to type 2 diabetes (T2D).
• Access to regular primary care via MHLA improved utilization for some conditions but highlighted ongoing T2D management challenges.

Conclusions:

• The My Health LA program appears effective in reducing some avoidable ED visits for undocumented populations.
• Targeted interventions may be needed for managing chronic conditions like type 2 diabetes among program participants.
• Healthcare access improves acute and chronic disease management but does not fully resolve all health disparities.