Health insurance status and the use of emergency and other outpatient services 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

Retrospective analysis of visits.

SETTING

Emergency department and outpatient clinics of an urban university hospital.

PARTICIPANTS

One hundred seventy-two subjects, who made 771 visits to the ED during 1990.

RESULTS

Of the 172 subjects, 31 were covered by commercial insurance, 32 were covered by Medicare, and 109 were covered by Medicaid or were uninsured. Insurance status and frequency of use of emergency services were independent (P > .05). On discriminant analysis, Medicaid-covered and uninsured subjects were correctly classified, but commercially insured and 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 younger, to be users of primary-care services, and to live closer to the hospital (P = .0004).

CONCLUSION

Provision of primary-care services or stable insurance in the form of commercial insurance or Medicare did not decrease use of emergency services in subjects with sickle cell disease in a group of patients selected from one urban academic ED.