Communities with high levels of uninsured, Hispanic, or immigrant residents generally have lower rates of per-person hospital emergency department use than other communities, according to a study by the Center for Studying Health System Change published in Health Affairs. The study found that ED use in 12 nationally representative communities varied considerably from the national average of 32 ED visits per 100 persons in 2003, ranging from a high of about 40 ED visits per 100 people in Cleveland to a low of 21 ED visits per 100 people in Orange County, Calif. But Cleveland, which has low rates of uninsured (7.9%) and noncitizen residents (2.6%), has high ED use, while Orange County, which has a large population of uninsured (18.2%) and immigrant residents (15.6%), has low ED use.
Although a rapid influx of immigrants may contribute to ED crowding in some individual hospitals, immigration is not a major contributing factor to ED crowding nationally, even in many communities that have a large population of Hispanic immigrants. Noncitizens in 2003 on average had about 17 fewer ED visits per 100 people than citizens, while uninsured people had 16 fewer visits on average than Medicaid patients, about 20 fewer visits than Medicare beneficiaries, and roughly the same rates as privately insured people. Variation in ED use across communities is not explained by differences in population and health system characteristics, and “reducing emergency department use defies simple solutions such as expanding insurance coverage or restricting access for undocumented immigrants,” said study author and senior HSC fellow Peter J. Cunningham. Rather, high ED use in part reflects patient preference for using EDs, regardless of income and insurance status, as well as practice patterns among physicians and other providers that favor greater use of EDs.
