Routine Emergency Department Use for Sick Care by Children in the United States

BACKGROUND: The use of the emergency departments as a regular source of sick care has been increasing, despite the fact that it is costly and is often an inappropriate source of care. This study examines factors associated with routine use of emergency departments by using a national sample of US children. METHODS: Data from the 1988 National Health Interview Survey on Child Health, a nationally representative sample of 17710 children younger than 18 years, was linked to country-level health resource data from the Area Resource File. Bivariate and multivariate analyses were used to assess the association between children's use of emergency departments as their usual sources of sick care and predisposing need and enabling characteristics of the families, as well as availability of health resources in their communities. RESULTS: In 1988 3.4% or approximately 2 million US children younger than 18 years were reported to use emergency departments as their usual sources of sick care. Significant demographic risk factors for reporting an emergency department as a usual source of sick care included black versus white race (odds ratio OR, 2.08), single-parent versus two-parent families (OR, 1.53), mothers with less than a high school education versus those with high school or more (OR, 1.76), poor versus nonpoor families (OR, 1.76), and living in an urban versus suburban setting (OR, 1.38). Specific indicators of need, such as recurrent health conditions (asthma, tonsillitis, headaches, and febrile seizures), were not associated with routine use of emergency departments for sick care. Furthermore, health insurance status and specifically Medicaid coverage had no association with use of the emergency department as a usual source of sick care. Compared with children who receive well child care in private physicians' offices or health maintenance organizations, children whose sources of well child care were neighborhood health centers were more likely to report emergency departments for sick care (OR, 2.01). Children residing in counties where the supply of primary care physicians was in the top quintile had half the odds (OR, 0.50) of reporting emergency departments as usual sources of sick care. CONCLUSIONS: Reliance on hospital emergency departments for routine sick care is strongly associated with demographic and social characteristics of the child and family, the type and source of available well child care, and the supply of primary care physicians. Because health insurance status was not a significant predictor of use, public policies aimed at reducing the use of emergency departments by children will need to address other factors. These include the organizational characteristics and responsiveness of the health care system and the motivation of families for routine use of hospital emergency departments.