INSURANCE-COVERAGE AND THE APPROPRIATE UTILIZATION OF EMERGENCY DEPARTMENTS

The authors explore the appropriate utilization of health services-spe cifically, emergency department services-by consumers with varying lev els and types of insurance coverage. The assumed appropriateness of in sured consumers' utilization behavior has been central to key analyses of health care reform proposals in recent years. The authors' results , derived from the 1992 National Ambulatory Medical Care Survey, sugge st that this assumption is flawed, which leads to questions regarding the efficacy of policy evaluations premised on this and related assump tions. Uninsured patients and those with various types of insurance co verage all have high rates of inappropriate emergency department utili zation. Compared to the uninsured, Medicaid patients have a higher rat e of inappropriate usage, whereas HMO and other prepaid patients have a lower rate of inappropriate utilization. In view of this study's fin dings, a reexamination of the various health care reform proposals usi ng a revised set of assumptions may yield decidedly different policy r ecommendations and implications.