Emergency Department Use in New York City: A Survey of Bronx Patients

In the absence of universal coverage and an effective primary care delivery system for vulnerable populations, hospital emergency departments (EDs) are the ultimate safety net for many patients. This is especially true in New York City, where nearly 75 percent of ED visits in 1998 were for nonemergent care, or for emergent care that could have been treated in a doctor's office.1 Another 7 percent of visits required care in the ED, but were for potentially preventable conditions such as acute flare-ups of asthma or diabetes. New Yorkers who rely on EDs lack continuity in their health care and end up using costlier services. Why do so many patients depend on hospital emergency departments for primary care? Do they seek emergency care immediately, or do they have time and opportunity to obtain care at a doctor's office or neighborhood clinic? Do these patients have a usual source of care other than the ED? Do they have any contact with the health care system prior to their ED visit? Does insurance status, race, ethnicity, national origin, or gender have an influence on ED use?

To answer these questions, the Center for Health and Public Service Research at New York University conducted face-to-face interviews with 669 emergency department patients ages 18 to 55 at four hospitals in the Bronx.