National Study of Health Insurance Type and Reasons for Emergency Department Use



The rates of emergency department (ED) utilization vary substantially by type of health insurance, but the association between health insurance type and patient-reported reasons for seeking ED care is unknown.


We evaluated the association between health insurance type and self-perceived acuity or access issues among individuals discharged from the ED.


This was a cross-sectional analysis of the 2011 National Health Interview Survey. Adults whose last ED visit did not result in hospitalization (n = 4,606) were asked structured questions about reasons for seeking ED care. We classified responses as 1) perceived need for immediate evaluation (acuity issues), or 2) barriers to accessing outpatient services (access issues).


We analyzed survey-weighted data using multivariable logistic regression models to test the association between health insurance type and reasons for ED visits, while adjusting for sociodemographic characteristics.


Overall, 65.0 % (95 % CI 63.0–66.9) of adults reported ≥ 1 acuity issue and 78.9 % (95 % CI 77.3–80.5) reported ≥ 1 access issue. Among those who reported no acuity issue leading to the most recent ED visit, 84.2 % reported ≥ 1 access issue. Relative to those with private insurance, adults with Medicaid (OR 1.05; 95 % CI 0.79–1.40) and those with Medicare (OR 0.98; 95 % CI 0.66–1.47) were similarly likely to seek ED care due to an acuity issue. Adults with Medicaid (OR 1.50; 95 % CI 1.06–2.13) and Medicaid + Medicare (dual eligible) (OR 1.94; 95 % CI 1.18–3.19) were more likely than those with private insurance to seek ED care for access issues.


Variability in reasons for seeking ED care among discharged patients by health insurance type may be driven more by lack of access to alternate care, rather than by differences in patient-perceived acuity. Policymakers should focus on increasing access to alternate sites of care, particularly for Medicaid beneficiaries, as well as strategies to increase care coordination that involve ED patients and providers.

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Dr. Ginde conceived and designed the study. Dr. Ginde and Mr. Rooks performed the statistical analysis. Dr. Capp drafted the manuscript. All authors participated in the analysis and interpretation of the data, and critically revised the manuscript for important intellectual content. Dr. Ginde takes responsibility for the manuscript as a whole.

Funding/Support and Role of the Sponsor


Conflicts of Interest

The authors declare that they do not have a conflict of interest.

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Correspondence to Adit A. Ginde MD, MPH.

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Capp, R., Rooks, S.P., Wiler, J.L. et al. National Study of Health Insurance Type and Reasons for Emergency Department Use. J GEN INTERN MED 29, 621–627 (2014).

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  • Emergency Department
  • Emergency Department Visit
  • Private Insurance
  • National Health Interview Survey
  • Access Issue