Health insurance, neighborhood income, and emergency department usage by Utah children 1996–1998

Emergency department usage rates were calculated from 1996 through 1998 using Utah ED data for children with commercial health insurance, Medicaid, for uninsured children, and by income group estimating neighborhood household income from Zip code of residence. We analyzed usage following the July 1996 transition of Utah Medicaid to managed care.Children with Medicaid had approximately 50% greater ED utilization rates than children with commercial health insurance or uninsured children. The majority of usage for Medicaid and uninsured children was for non-traumatic conditions. Only 35% of total ED usage was for non-emergent or non-urgent conditions and this was related to both Medicaid and low household income. Children lacking health insurance were more likely to be discharged against medical advice (OR = 2.36, 95% C.I. 1.88–2.96). There was no reduction in Medicaid ED usage following the transition to managed care.Usage of ED services is related to both health insurance status and income. Children lacking health insurance and Medicaid children have excessive usage for conditions which could be treated in a primary care setting. That managed care does not reduce Medicaid ED usage is consistent with findings of other studies.The increase in utilization of emergency medical services in the U.S. and other developed countries in recent decades is related to availability of ambulatory medical services and to the provision of health insurance [1]. Acute injury [2], longevity [3], and health insurance coverage across an array of conditions [4] are related to the absolute and relative distribution of income in a society. In the United States it is estimated that from 40% to 60% of ED visits are for non-urgent conditions and that such usage is related to availability, social and economic factors, availability of other medical services, and consumer choice [5].The Emergency Medical Treatment and Active Labor Act of 1986 mandates that hospital emergency departments provide car