HEALTH-INSURANCE STATUS AND THE USE OF EMERGENCY AND OTHER OUTPATIENTSERVICES BY ADULTS WITH SICKLE-CELL DISEASE

Study objective: To evaluate insurance status and frequency of use of emergency services in adults with sickle cell disease. Design: Retrosp ective analysis of visits. Setting: Emergency department and outpatien t clinics of an urban university hospital. Participants: One hundred s eventy-two subjects, who made 771 visits to the ED during 1990. Result s: Of the 172 subjects, 31 were covered by commercial insurance, 32 we re covered by Medicare, and 109 were covered by Medicaid or were unins ured. Insurance status and frequency of use of emergency services were independent (P>.05). On discriminant analysis, Medicaid-covered and u ninsured subjects were correctly classified, but commercially insured acid Medicare subjects were not. Medicaid and uninsured subjects were more likely to be younger and to live closer to the hospital (P<.00005 ). High-frequency users of emergency services were discriminated from low-frequency users. High-frequency users were more likely to be young er, to be users of primary-care services,and to live closer to the hos pital (P=.0004). Conclusion: Provision of primary-care services or sta ble insurance in the form of commercial insurance or Medicare did not decrease use of emergency services in subjects with sickle cell diseas e in a group of patients selected from one urban academic ED.