The Effects of Access to Pediatric Care and Insurance Coverage on Emergency Department Utilization

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Abstract
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.