Insurance coverage and the appropriate utilization of emergency departments

The authors explore the appropriate utilization of health services-specifically, emergency department services-by consumers with varying levels and types of insurance coverage. The assumed appropriateness of insured 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, suggest that this assumption is flawed, which leads to questions regarding the efficacy of policy evaluations premised on this and related assumptions. Uninsured patients and those with various types of insurance coverage all have high rates of inappropriate emergency department utilization. Compared to the uninsured, Medicaid patients have a higher rate of inappropriate usage, whereas HMO and other prepaid patients have a lower rate of inappropriate utilization. In view of this study's findings, a reexamination of the various health care reform proposals using a revised set of assumptions may yield decidedly different policy recommendations and implications.