Underinsured “consumerism” in nonemergent care: Emergency or primary care

BACKGROUND: Most patients are aware of Emergency Department (ED) community-based alternatives for care of nonemergent medical problems, yet still choose the hospital-based ED. This qualitative study's aim was to explore underinsured patient decisions in Northern Colorado concerning emergency rather than primary care for nonemergent issues. METHODS: Secondary analysis of four 2006 Northern Colorado emergency department patient focus group data. Original subjects were recruited in collaboration with a state-of-the-art medical facility that services a population with a median income of $38,458 and who are approximately one third Latino/Hispanic. Sampled from the 2005 ED patient roster, participants were selected based on several factors: 1) the day and time the patient presented at the ED; 2) whether the patient was uninsured or underinsured; and 3) if the issue was nonemergent as indicated by coding of Levels I, II, or III. 47 patients/parents participated. IRB approval was obtained from Banner Health Human Subjects Review Committee. Qualitative analysis used an editing approach that allowed for emerging themes influencing patient utilization choices. RESULTS: Influential factors included definitions of “emergency,” and if child was the patient. 24 hours/7 days a week access and universal acceptance regardless of financial status were convenience themes. Perceptions of prompt attentiveness, higher ED personnel competency, more respectful and culturally sensitive treatment, and availability of comprehensive “one stop shop” services influenced choice. Descriptions of ideal nonemergent care reflected these factors. Other suggestions included central location with ease of access, respectful treatment, phone triage to aid decision making, multidisciplinary services, and flexible payment options including community service payback. DISCUSSION/CONCLUSION: Community clinics are increasingly being asked to consider “the medical home model: a vision of care from the perspective of a patient and his/her family. The model includes around-the-clock access to medical consultation and a comprehensive approach and coordination of care through providers and community services – all factors shown in this study to be important in un- and underinsured care decision-making. While financial status may limit care options, the decision process proved thoughtful for participants. Results suggest concern for children and convenience factors rather than access issues influence care seeking. “Consumerism” should be considered when developing care options for this population. While this sample was resigned to expect poor treatment to get needed services, their consumer behavior seeks respectful treatment. Given its omnipresence, the Golden Rule should not be under-emphasized in staff training programs.