ROUTINE EMERGENCY DEPARTMENT USE FOR SICK CARE BY CHILDREN IN THE UNITED-STATES

Background. The use of the emergency departments as a regular source o f sick care has been increasing, despite the fact that it is costly an d is often an inappropriate source of care. This study examines factor s associated with routine use of emergency departments by using a nati onal sample of US children. Methods. Data from the 1988 National Healt h Interview Survey on Child Health, a nationally representative sample of 17 710 children younger than 18 years, was linked to county-level health resource data from the Area Resource File. Bivariate and multiv ariate analyses were used to assess the association between children's use of emergency departments as their usual sources of sick care and predisposing need and enabling characteristics of the families, as wel l as availability of health resources in their communities. Results. I n 1988 3.4% or approximately 2 million US children younger than 18 yea rs were reported to use emergency departments as their usual sources o f sick care. Significant demographic risk factors for reporting an eme rgency department as a usual source of sick care included black versus white race (odds ratio [OR], 2.08), single-parent versus two-parent f amilies (OR, 1.53), mothers with less than a high school education ver sus those with high school or more (OR, 1.76), poor versus nonpoor fam ilies (OR, 1.76), and living in an urban versus suburban setting (OR, 1.38). Specific indicators of need, such as recurrent health condition s (asthma, tonsillitis, headaches, and febrile seizures), were not ass ociated with routine use of emergency departments for sick care. Furth ermore, 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 p rivate physicians' offices or health maintenance organizations, childr en whose sources of well child care were neighborhood health centers w ere more likely to report emergency departments for sick care (OR, 2.0 1). Children residing in counties where the supply of primary care phy sicians was in the top quintile had half the odds (OR, 0.50) of report ing emergency departments as usual sources of sick care. Conclusions. Reliance on hospital emergency departments for routine sick care is st rongly associated with demographic and social characteristics of the c hild and family, the type and source of available well child care, and the supply of primary care physicians. Because health insurance statu s was not a significant predictor of use, public policies aimed at red ucing the use of emergency departments by children will need to addres s other factors. These include the organizational characteristics and responsiveness of the health care system and the motivation of familie s for routine use of hospital emergency departments.