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International Journal of Family Medicine
Volume 2014 (2014), Article ID 842847, 5 pages
Research Article

The Impact of Insurance and a Usual Source of Care on Emergency Department Use in the United States

1Department of Family Medicine, Virginia Commonwealth University, 3650 Joseph Siewick Drive, No. 400 Fairfax, Richmond, VA 22033, USA
2The Robert Graham Center, 1133 Connecticut Avenue, NW Suite 1100, Washington, DC 20036, USA
3Department of Family Medicine, Georgetown University, 4000 Reservoir Road, NW, Washington, DC 20007, USA

Received 25 October 2013; Revised 19 December 2013; Accepted 22 December 2013; Published 9 February 2014

Academic Editor: Carolyn Chew-Graham

Copyright © 2014 Winston Liaw et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Finding a usual source of care (USC) is difficult for certain populations. This analysis determines how insurance type and having a USC affect the settings in which patients seek care. Methods. In this cross-sectional study of the 2000–2011 Medical Expenditure Panel Surveys, we assessed the percentage of low-income persons with half or more of their ambulatory visits to the emergency department (ED). Respondents were stratified based on insurance type and presence of a USC. Results. In 2011, among Medicaid enrollees without USCs, 21.6% had half or more of their ambulatory visits to EDs compared to 8.1% for those with USCs. Among the uninsured without USCs, 24.1% went to an ED for half or more of their ambulatory visits compared to 8.8% for those with USCs in 2011. Among the privately insured without USCs, 7.8% went to an ED for half or more of their ambulatory visits compared to 5.0% for those with USCs in 2011. These differences remained in multivariate analyses. Conclusions. Those who lack USCs, particularly the uninsured and Medicaid enrollees, are more likely to rely on EDs.