Presence of a Community Health Center and Uninsured Emergency Department Visit Rates in Rural Counties

Abstract

1,2 ED visits by uninsured patients create a special problem for hospitals and society because the burden of indigent care in a costly ED setting is borne by other patients, payors, and their communities. In most states, uninsured rates are higher in rural areas than in urban areas, and the financial burden of uninsured ED visits has a direct impact on the financial viability of small rural hospitals.

Reducing inappropriate accident and emergency department attendances:

“…Although actual, 30,42 or perceived, 43 absence of primary care does result in increased emergency attendances, findings from this review support the notion that increasing access points for urgent care may unmask latent demand that is more likely to be inappropriate for A&Es. Cost savings across the urgent care sector as a whole may be negated by the additional cost of providing new services; in addition, there is a risk of service duplication with disruption to continuity of care because of provider proliferation.…”

“…However, no significance levels were provided and the methodology for this narrative review is unclear. 30 The second study, a cross-sectional analysis of the impact of community health centres across a single state in the US, found a significant reduction (RR [relative risk] = 1.33, 95% CI = 1.11 to 1.59) in A&E attendance for ambulatory care-sensitive presentations in areas with community health centres, compared with those areas without.…”

“…Neither of the studies addressing community health centres 29,30 were eligible for quality assessment. Conducted in the US, both showed reductions in inappropriate attendances among individuals who were uninsured.…”

Costs and Clinical Quality Among Medicare Beneficiaries: Associations with Health Center Penetration of Low-Income Residents

“…Access to primary care is particularly beneficial among underserved or low-income individuals, where it has been linked to fewer preventable hospitalizations and emergency department (ED) visits (Falik, Needleman, Wells, & Korb, 2001;Probst, Laditka, & Laditka, 2009;Rust et al, 2009;Tom et al, 2010). The savings from providing highquality primary care to low-income individuals can potentially accrue to a large proportion of Medicare beneficiaries, given that an estimated 39% meet the federal definition for low income in 2010 (U.S. Census Bureau, 2010).…”

Emergency Care Services

“…Community care centres could potentially generate a 30% saving on annual Medicaid spending by preventing avoidable visits to EDs. The reduction of ED visits related to the establishment of community health centres is particularly visible for uninsured patients (Rust et al 2009). …”