Determinants of Emergency Department Choice and Switching: Evidence from Winnipeg, Manitoba

In Canada's universal healthcare system, disparities in emergency department (ED) utilization remain despite equal access. Patients' self-selection behaviors-shaped by geographic, social, and experiential factors-lead to demand imbalances that hinder equitable care delivery.

This study investigates the factors that influence patient choice and switching behavior among major EDs in Winnipeg, Manitoba, to understand how demographic, spatial, and experiential factors affect hospital selection and revisits.

Using five years of administrative data (April 2013-May 2018) covering 596,778 ED visits across Winnipeg's three largest hospitals, we employed multiple logistic, multinomial, and Poisson regression models to analyze (i) the odds of selecting the nearest ED, (ii) the relative risk of choosing one ED over another, and (iii) the likelihood and rate of ED switching among returning patients.

Only about 40% of patients selected the nearest ED, indicating that proximity alone does not determine choice. Some hospitals attracted older or higher-acuity patients despite longer travel distances, suggesting that perceived differences in service capability or accessibility may influence choice. The most influential factor in switching behavior was a change in patient address: individuals who relocated had 84.7% higher odds of switching and nearly double the switching rate. Frequent users and those with leave-against-medical-advice (LAMA) or leave-without-being-seen (LWBS) events were also more likely to switch.

Residential mobility, repeated use, and negative care experiences strongly influence ED choice-switching. Incorporating these behavioral insights into resource allocation and hospital coordination can enhance efficiency and promote equitable access within Canada's universal healthcare system.