Emergency room use and access to alternative sources of care

Abstract

In recent years a great deal of attention has been called to the extent to which emergency rooms (ERs) in the United States are being used for routine -rather than emergency -care. In attempting to explain this extensive routine use, many scholars have surmised that much of this use occurs among people for whom the emergency room is the onlyor is the most convenient -health care facility available. That is, many researchers have posited that the emergency room serves to extend health services to medically disadvantaged persons who might otherwise have no convenient access to care. Of course, such a claim has profound implications for the role of the emergency room in bringing about an equitable distribution of medical resources. Yet in spite of the importance of this issue, few studies have provided empirical evidence useful for assessing the claimed relationship between emergency room utilization and access to altemative sources of care. The present study seeks to close this research gap by employing national survey data to examine emergency room visits in light of the accessibility of more traditional provider settings. Multiple Classification Analysis is used to analyze the data, and comparisons are made for the sample as a whole as well as for three critical explanatory variables: income, age, and residence. In addition, four indicators of illness are used as controls. Findings suggest that, contrary to what has previously been surmised, emergency room visitation often occurs independently of, rather than as a substitute for, access to non-ER health care settings. Finally, implications of these findings and directions for future research are discussed.As a number of health services scholars (1,2) have recently pointed out, the growing use of the hospital emergency room (ER) for the treatment of elective -rather than urgent or emergent -medical conditions has become a major issue in US emergency room care. In point of fact, there is a substantial body of evidence (3) that hospital emergency departments now see primarily non-urgent health problems which might more traditionally be treated at a doctor's office. In Roth's (4) words, 'Hospital emergency services handle largely routine "walk-in" cases ... "urgent" (cases) ... range from six to (only) ten percent of the total emergency department census. ' And Roskies et al. (5) agree that

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“…1 In addition, EDs often see more patients in a given time period than they have resources to provide care. [2][3][4][5] In response to this issue, triage systems have been implemented to prioritize and allocate patients for these scarce resources. [6][7][8][9][10] Given this vital role, initial triage designation can have a significant impact on any given patient's experience in times of emergency illness.…”

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