The 130th Annual Meeting of APHA

Abstract #46200

William G Johnson, PhD¹, Amy M. Bartels, MPH¹, and Saundra E. Johnson, MPA². (1) School of Health Administration and Policy and Department of Economics, Arizona State University, Box 874506, Tempe, AZ 85287-4506, (2) Flinn Foundation, 1802 N. Central Ave, Phoenix, AZ 85004

Introduction: This study uses micro-data from a unique community health data system to compare patterns of health care utilization for children who utilize hospital inpatient, emergency department, pediatric physicians and community health centers for a twelve-month period. We examine questions on access to care including the effect of health insurance on primary care access; the use of emergency department services to serve primary care needs; and the effects of primary care deficits on the severity of ambulatory care sensitive health conditions.

Population: Yuma County is a sparsely populated rural county spanning more than 5,000 square miles in the southwestern corner of Arizona. The county is unique because of its proximity to the Mexican border, the presence of relatively large numbers of migrant workers, and a small population dispersed across a large geographic area. These characteristics make it especially difficult for children to obtain adequate health insurance coverage and primary care services. More than 60 percent of the children are Hispanic.

Methods: Data from the county’s health care providers and health-related organizations is used to create the community health data system (CHDS). Data from the primary ‘safety-net’ health care organizations, state Medicaid and immunization data, employer-based health insurance claims data for two employers and an annual survey of primarily Hispanic neighborhoods are merged to create the CHDS.

Results: Access and service utilization results are based on 23,462 children in the CHDS who utilized some form of health care in 1999. The Yuma Regional Medical Center emergency department was the sole provider of care for 20% of the children who received care in 1999. Slightly more than one-fifth of the children were uninsured, representing 39 percent of all uninsured children who received care from any source. A smaller proportion but much larger number of insured children, however, also used the emergency department as their sole provider.

An analysis of ambulatory care sensitive conditions showed, with few exceptions, no significant relationship between insurance coverage and admissions for these conditions.

Conclusion: The findings show that health insurance coverage improves access to primary care for children but does not eliminate other obstacles to regular care. For example, migrant farm workers receive health insurance during their seasonal employment. Many workers and their families remain in the community during the off-season and continue to need services but are uninsured. Results suggest that limitations on access to primary physicians include office hour restrictions, language barriers and transportation problems.

Learning Objectives:

• Identify patterns of health care utilization among hospital inpatient, hospital emergency department, pediatric physicians and community health centers for children.
• Describe the effect of health insurance on access to primary care and the use of the emergency room to serve primary care needs.
• Articulate how to use administrative data to examine individual patterns of care.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.