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APHA Scientific Session and Event Listing

Sean Michael Orzol, MPH and Chris Trenholm, PhD. Mathematica Policy Research, 600 Alexander Park, Princeton, NJ 08540, 609-750-4048, sorzol@mathematica-mpr.com

Objective. We tested the conventional wisdom that health insurance coverage, by improving access to and use of primary care, reduces acute care utilization. Methods. The data for this analysis are drawn from a survey conducted in 2003-2004 of 1,235 families with a child enrolled in Healthy Kids, a local health coverage program in Santa Clara County, California. Most of these children have undocumented immigration status and live in households with income below 250 percent of the Federal Poverty Level. To measure the impacts of Healthy Kids, we examine four measures of emergency department (ED) use and hospitalization in the most recent six months. We derive our estimates from a quasi-experimental design that compares the outcome measures of two groups sampled for the survey— (1) an intervention group of children who had been enrolled in Healthy Kids for roughly one year, and (2) a comparison group of children who had recently been made eligible for Healthy Kids. Results. Despite dramatic improvements in children's access to and use of medical and dental care services as a result of enrolling in Healthy Kids, we find that the program had no impact on children's use of ED services or their rate of hospitalization. In fact, the proportion of children reported to have an ED visit in the most recent six months was higher among children enrolled in Healthy Kids, 15.7 percent, than for children without Healthy Kids, 11.3 percent (p = 0.054). Similarly, enrollment in Healthy Kids had no significant impact on overnight hospitalizations (2.3 percent post-HK versus 2.4 percent pre-HK; p = 0.899). Discussion. It is commonly believed that a main factor behind the increase in ED use is the increasing number of individuals who are uninsured or lack an appropriate usual source of care.^1,2,3 Our findings contradict this conventional wisdom. One reason may be the presence of non-financial barriers, such as transportation difficulties and parental work responsibilities, that prohibit parents from using a recommended source of care. Alternatively, given the historically poor access of most children enrolled in Healthy Kids, it may take some time for families to change familiar patterns of care use and begin to seek care in recommended settings. Other evidence suggests this may be the case, as Healthy Kids enrollees are less likely to report the ED as the usual source of primary care, implying some early signs of behavior change.

Learning Objectives:

• The session intends to shed light on the association between Health Insurance, Access to Care and Emergency Department Use.

Keywords: Health Insurance, Emergency Department/Room

Presenting author's disclosure statement:

Any relevant financial relationships? No