Unmet healthcare need among US children increases subsequent ambulatory care sensitive utilization

Ambulatory care sensitive (ACS) emergency room and inpatient utilization is costly and may contribute to worse health outcomes. We sought to determine if unmet healthcare need was associated with ACS utilization among children in the US, using a nationally representative, population-based sample. We examined data on 22,581 children (age 0-17) from the 2002-2007 Medical Expenditure Panel Survey. Unmet need was defined as delayed or forgone healthcare during the first survey year. ACS utilization during the second survey year was evaluated using standard algorithms. Multivariable logistic regression was used to determine if children who experienced unmet need were more likely to have any ACS utilization in the following year, adjusting for relevant covariates. Overall, 3.12% of children experienced any ACS utilization, and 5.96% of children experienced any unmet need. The unadjusted rate of ACS utilization among children with unmet need was 4.77%, compared to 3.02% for those without unmet need (p<0.01). Children who experienced any unmet healthcare need during the first survey year had 69% higher odds of any ACS utilization during the second survey year (95% CI: 1.15-2.49), adjusting for health insurance, usual source of care, family income and sociodemographics. Additional disparities existed. As ACS utilization was associated with prior unmet need for US children, families may be substituting prior delayed or forgone ambulatory care with emergency room and inpatient care. Reducing unmet need may improve health outcomes for children by increasing their opportunity to receive timely and appropriate preventive care, rather than more costly acute care.