Patient Motivators for Emergency Department Utilization: A Pilot Cross-Sectional Survey of Uninsured Admitted Patients at a University Teaching Hospital

Abstract

, Abstract-Background: During the past several decades, emergency department (ED) increasing volume has proven to be a difficult challenge to address. With the advent of the Affordable Care Act, there is much speculation on the impact that health care coverage expansion will have on ED usage across the country. It is currently unclear what the effects of Medicaid expansion and a decreased number of uninsured patients will have on ED usage. Objective: We sought to identify the motivators behind ED use in patients who were admitted to a university teaching hospital in order to project the possible impact of health care reform on ED utilization. Methods: We surveyed a convenience sample of uninsured patients who presented to the ED and were subsequently admitted to the inpatient setting. Results: Our respondents sought care in the ED primarily because they perceived their condition to be a medical emergency. Their lack of insurance and associated costs of care resulted in delays in seeking care, in reduced access, and a limited ability to manage chronic health conditions. Thus, contributing to their admission. Conclusions: Affordability will reduce financial barriers to health care insurance coverage. However, efficient and timely access to primary care is a stronger determinant of ED usage in our sample. Health insurance coverage does not guarantee improved health care access. Patients may continue to experience significant challenges in managing chronic health conditions. Ó 2015 Elsevier Inc.

Population-based surveillance of medical tourism among US residents from 11 states and territories: Findings from the Behavioral Risk Factor Surveillance System

“…This finding suggests that the care was either not covered or was inadequately covered by insurance. Medical tourists who are uninsured or underinsured may be hesitant to present to US healthcare facilities because of the costs of treatment, 19 or to provide details of their care for fear that follow-up care will not be covered by their insurance. Medical tourists in our sample traveled to Mexico and Canada frequently, but more than half of all visits were to other destinations.…”

Patient Presentations in Outpatient Settings

“…1 Rates among privately insured patients were much lower. The extent to which this affects national estimates and changes in emergency department presentation over time can be appreciated in several ways: 1) While presumed reasonable to match uninsured use to Medicaid rates in an outpatient setting given the tendency for patients’ ability to pay to influence injury-related utilization of outpatient care, 14,29–31 application of the same standard to emergency department settings for the sake of consistency in this study represents an anticipated underestimate of uninsured emergency department use that likely explains much of the difference between CDC overall emergency department estimates 1 and those extrapolated from MarketScan rates (eTable 1); 2) emergency department estimates reported by the CDC on a national scale include all emergency department presentations, including those subsequently transferred/readmitted to higher levels of care and without exclusion for prior head trauma-related health-system use; 1 3) Both datasets represent weighted administrative claims on which varying assumptions are based. 32…”

Associations between Adverse Childhood Experiences and Emergency Department Utilization in an Adult Medicaid Population

“…High ED utilization is problematic for both patients and health systems. When used in place of ambulatory care, ED use can lead to a lack of continuity of care, delays in seeking needed care, and limited ability to manage chronic conditions, all of which can further widen health disparities already experienced by low-income populations [ 24 , 25 ]. For health systems, ED use is more expensive and consumes more resources than primary care, leading to higher expenditures and growing costs of care [ 26 , 27 ].…”