Routine Emergency Department Use of Sick Care By Children in the United States

The use of emergency departments as a regular source of sick care has been increasing, even though it is costly and often an inappropriate source of care. This study examines factors associated with routine use of emergency departments, using data from the 1988 National Health Interview Survey on Child Health, a nationally representative sample of 17,710 children younger than 18 years. The authors found that, in 1988, 3.4% of U.S. 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 being black, a single-parent, and poor, living in the central city, and having a low level of education. 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. Children in counties where the supply of primary care physicians was high had half the odds of reporting emergency departments as usual sources of sick care.