A trend analysis of hospitals as a usual source of medical care

Purpose/Aims: To identify the number and type of U.S. residents who identify the hospital emergency department or other hospital unit as their usual source of medical care.

Rationale/Conceptual Basis: In accordance with Anderson's behavioral model of health care access, the likelihood of reporting the hospital as one's usual source of medical care was hypothesized to be a function of predisposing (age, sex, race/ethnicity, region), enabling (income, health insurance coverage), and need (self-assessed health status) variables.

Methods: Trend analyses of the 1997-2006 National Health Interview Surveys (NHIS) and logistic regression analyses of the 2006 NHIS. The population studied is a representative national sample of non-institutionalized adults and children.

Results: The proportion of Americans who describe the hospital emergency department or other outpatient unit as their usual source of care has declined slightly over the past decade, from 3.1% in 1997 to 2.2% in 2006. However, over 5.5 million Americans continue to identify the hospital emergency department or other outpatient units as their usual source of care. Working-age adults, males, racial and ethnic minorities, persons with public insurance, and those without health insurance are more likely to identify the hospital as a usual source of care.

Significance of findings/Implications: Working towards universal access requires an understanding of persisting disparities in healthcare access and utilization and knowledge of the most effective sources of medical care. The hospital emergency department and other hospital units are generally considered an inefficient source of primary care. However, the decline in the proportion of Americans who identify the hospital as their usual source of care does not necessarily represent improved access. Structural changes, including emergency department closures, increased crowding, and aggressive hospital billing practices may deter usage. The expansion of proprietary urgent care clinics may also offer a less expensive alternative. Finally, expansion of public insurance programs, particularly the SCHIP program, may allow some families to access physician clinics and private practices.