Online Program

An Empirical Study of Emergency Department Access by Uninsured Populations in Multilevel Context

Monday, November 2, 2015

Theresa Ortiz, MA, Evaluation, Kern County Children and Families Commission, Bakersfield, CA
Diana Navarro, BS, Evaluation, Kern County Children and Families Commission, Bakersfield, CA
Jianjun Wang, Ph.D., Advanced Educational Studies, California State University, Bakersfield, CA
Summer Wang, Chemistry, UCLA, Bakersfield, CA
Libing Wang, Med Student/BS from Berkeley, Medical School, NYU Medical School, New York, NY
Roland Maier, MA, First 5 Kern, Bakersfield
Objectives.A new report from the National Center for Health Statistics suggests a strong need for examining a longstanding myth that uninsured patients are clogging the nation’s emergency rooms for lacking a primary care provider.  In this proposed presentation, we employ large-scale state and national data to disentangle factors of emergency department (ED) access by uninsured populations in multilevel context.

Methods. Empirical data on ED access from the Office of Statewide Health Planning and Development (OSHPD) are merged with American Community Survey (ACS) data from U.S. Census Bureau to support analyses of ED access by uninsured populations.  Contextual factors were examined at county and community levels using a well-established Context, Input, Process, and Product (CIPP) model.

Results.  Significant impact has been found from family income, population density, and insurance coverage at the community level.  Model-fit indices indicated a consistent support for fitting the empirical data with a multilevel model.  This study not only reconfirms common factors of public health, but also enriches the existing literature through an investigation of Proposition 10 impact in California.

Conclusions. Our findings support the employment of variance partition and multilevel modeling to assess the impact of ED access by uninsured populations.  Profound needs have been identified to reduce the cost of ED services and save them for medically needed and traditionally underserved populations.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Planning of health education strategies, interventions, and programs
Provision of health care to the public
Public health or related research

Learning Objectives:
Analyze multilevel factors that impact emergency department (ED) access by uninsured populations under multilevel context; Evaluate variable selections according to a CIPP model that fits ICEHS’ healthography – “How Where you Live Affects Your Health and Well-being”; Assess the policy impact from Proposition 10 that pertains to the OSHPD outcome measures of ED access in California.

Keyword(s): Accessibility, Emergency Medical Services

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have presented at APHA last year. In addition, I have working as a Senior Research Analyst in healthcare support for more than nine years.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.