Understanding the relationship between barriers to timely primary care and emergency department utilization across insurance categories : an analysis of the National Health Interview Survey Data (1999-2011)
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In the United States (US), where access to and affordability of healthcare remains a critical challenge, emergency departments (ED) have increasingly served as a source for primary care and a portal to hospital admissions. Although barriers to timely primary care and lack of insurance are considered influential factors, the inter-relationship between these issues and ED use is not well-understood. We, therefore, examined the relationship between self-reported insurance status, perceived barriers and ED use among non-institutionalized US adults. We analyzed data from 378,502 participants of the 1999 to 2011 National Health Interview Survey. The following were considered as barriers to timely primary care as experienced during the past year: unable to get through on telephone, unable to obtain appointment soon enough, long wait in the physician’s office, limited clinic hours, and lack of transportation. Individuals were classified by source of insurance into Private, Medicare, Medicaid, Other insurance, and No insurance. National estimates were obtained using appropriate sampling weights. Logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) for ≥ 1 ED use and to test for the interaction between self-reported barriers and source of insurance. Overall, 10.0% of adults had ≥ 1 barrier to care and 20.2% reported ≥ 1 ED visit in the past year. Insurance profile was as follows: Private (57.8%), Medicare (17.7%), Uninsured (16.3%), Medicaid (5.0%), and Other Insurance (2.6%). Compared to those without any barrier, adults who experienced ≥ 1 barriers were more likely to report ≥ 1 ED visits in the past year (32.6% vs. 18.8%). In multivariate models that included both barriers and source of insurance, the odds of an ED visit was greater among adults with ≥ 1 vs. no barriers (OR [95%CI] - 2.01 [1.95-2.07]), and varied across source of insurance (OR [95%CI]-Private: reference; Medicare: 1.76 [1.72 - 1.81]; Medicaid: 3.11 [3.00-3.23]; Other: 1.83 [1.73 – 1.94]; Uninsured: 1.26 [1.23 - 1.30]). The magnitude of association between barriers and ED use varied across insurance categories. Among non-institutionalized adults in the US, the source of insurance was seen to influence the association between perceived barriers to timely care and ED use. Further analyses are planned to determine whether this relationship persists after controlling for socio-demographic and clinical characteristics.
Table of Contents
Introduction -- Review of literature -- Methodology -- Results -- Discussion -- Reference list -- Vita