The 130th Annual Meeting of APHA

Abstract #50585

Mona Sarfaty, MD, Prevention and Community Health, George Washington University School of Public Health and Health Services and the Primary Care Coalition of Montgomery County, MD, 8757 Georgia Avenue, 10th Floor, Silver Spring, MD 20910, 301-628-3413, mona_sarfaty@primarycarecoalition.org and Graham Atkinson, DPhil, Consultant, 1449 44th Street, NW, Washington, DC, DC 20007-2002.

While poor access for the uninsured and resultant use of ER’s is well documented, it is presumed to be less of a problem in suburban communities where medical resources are ample. A study of ER visits in Montgomery County, Maryland, an affluent suburban county adjacent to Washington, DC, was conducted to assess this presumption. The Health Services Cost Review Commission (HSCRC) sets rates for each hospital in Maryland based in part on the amount of uncompensated care provided. The HSCRC recently released data on ambulatory visits at the five hospitals in Montgomery County, providing an opportunity to analyze emergency room (ER) use. Only visits not resulting in hospital admission were included in the analysis. The rate of ambulatory visits to the ERs showed marked variation by age and insurance status. The two best insured groups, children and the elderly, visited ERs at a rate proportional to their representation in the population. The age group with the lowest rate of insurance coverage(age19-44) visited ERs at a markedly higher rate than its representation in the population (p<0.01). In addition, the two age groups with the lowest rates of insurance coverage (ages 19-44 and 45-64) showed a markedly higher proportion of uninsured ER visits than their proportion of overall ER visits (p<0.01). The opposite was true for children and those aged 65 and over (p< 0.01). These data demonstrate that poor access to care and resultant overuse of ERs is a significant problem in suburban areas.

Learning Objectives:

• The participant will be able to identify age groups within the population with the poorest rates of insurance coverage.
• The participant will develop an understanding of the problem of access to care in suburban communities.
• The participant will recognize the problem of overuse of emergency rooms for ambulatory care.

Keywords: Access to Care, Health Insurance

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.