Hispanic ethnicity and public clinic use as predictive factors of emergency department utilization

Significance: Minimal quantitative data exist to support recent policy recommendations suggesting safety net expansion to decrease emergency department (ED) use and increase access among uninsured Hispanics. Objective: Investigate Hispanics' public clinic use and the impact on ED utilization. Methods: The nationally representative, telephonic 2005 National Health Interview Survey clustered random sample (n=98,648) provided data. Bivariate analyses examined associations among predictor variables. A multivariate ordinal logistic regression model predicted the number of times respondents used the ED in the past year. Model covariates included Hispanic ethnicity (n=23,642), birthplace, clinics as usual care source, uninsurance, income, race, and health status. Findings: Of Hispanics, 31.8% reported being uninsured and 46.6% reported annual household incomes <$20,000. Hispanic ethnicity was significantly associated with clinic use (p=<.0001). Of those who used clinics, 32.0% were Hispanic. Significant predictors of ED use were clinic as usual care source (p=.011), income (p=<.001), and health status (p=.006). The odds of presenting at the ED ³2 times in the past 12 months versus <2 times significantly increased by 2.57 times for persons whose usual care source was a public clinic (p=.012, CI=1.23, 5.37). Conclusions: Persons receiving care from a safety net source, rather than foregoing care, can require more specialized levels of care than what public clinics provide. Lower incomes among Hispanics may influence ED use through lack of insurance and primary care, resulting in preventable, emergent conditions. Policies targeting access for Hispanics should account for safety net care for the uninsured who require care beyond that offered at public clinics.