The effects of access to pediatric care and insurance coverage on emergency department utilization.

Objective: To compare children who used the emergency department (ED) in a rural, border community with those who did not over a 1-year period to estimate the effects of access to pediatric care, insurance coverage, ethnicity, gender, age, and area of residence on ED utilization.

Design: Multivariate logit models are used to estimate the independent influence of demographic characteristics, insurance coverage, and access to pediatric care on ED utilization during 1999 by children 0 to 19 years of age.

Results: Controlling for age, gender, ethnicity, and area of residence, children who received care from a private practice pediatric group were 73% less likely to utilize the ED if insured and 93% less likely if uninsured to use the ED than children who had not visited a pediatrician. Uninsured children were nearly 4 times more likely to use the ED than insured children. Among insured children, those covered by Medicaid were 54% less likely to use the ED than children with private insurance. Compared with white, non-Hispanic children, Asian or Hispanic children were no more likely to use the ED. Insured Native American children were more than twice as likely as white, non-Hispanic children to utilize the ED.

Conclusions: Access to pediatric care is associated with a marked decrease in ED utilization regardless of insurance status. This decrease in ED utilization is especially large for uninsured children.