Contrary to the idea that convenience prompts many privately insured people to seek care in emergency departments, the people most likely to use EDs believe they need urgent medical attention, according to a study by the Center for Studying Health System Change for the National Institute for Health Care Reform.

Patients' perceptions of the severity of their medical problems and whom they first contact for help or advice are the factors most associated with whether they seek ED care, according to the study. Nearly a quarter of respondents (23 percent) reported having an urgent medical problem in the three months before the survey, and almost half (44 percent) of those with an urgent condition ultimately went to an ED for treatment. Of people with an urgent problem, nearly half first contacted their regular source of care — typically primary care clinicians — and those patients were less likely to go to EDs. Another 20 percent called 911 or went straight to the ED, and 17 percent first contacted or visited an urgent care center.

Only rarely did respondents cite convenience as a reason for choosing ED care. Moreover, people who reported that their primary physicians offered rapid access to advice and visits were significantly less likely to use EDs and, instead, relied on their primary clinicians for urgent medical needs. However, despite their relatively comprehensive health coverage, the majority of respondents indicated they lacked this level of primary care access.

The report also found that people with coverage through a health maintenance organization were more likely to contact their doctors when seeking urgent care (52 vs. 43 percent) and were less likely to call 911 or go straight to the ED (17 vs. 22 percent).

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