Pediatric Emergency Departments: "Safety-Net" Providers for Vulnerable Children Page: 55
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PEDrATRIC EMERGENCY DEPARTMENTS
and early detection of disease (Christakis,
Mells, Koepsell, Zimmerman, & Connell, 2001;
Christakis, Wright, Koepsell, Emerson, &
Connell, 1999; Starfield, 1998).
Nevertheless, vulnerable adults (Baker,
Stevens & Brook, 1994; Aday, 1993; Stern,
Weissman, & Epstein, 1991; Dickhudt,
Gjerdingen & Asp, 1987; Lavenhar, Ratner, &
Weinerman, 1968) and children (Halfon,
Newacheck, Wood, & St. Peter, 1996; St. Peter,
Newacheck & Halfon, 1992; Field, Black,
Kincannon, & Arnold, 1987) (lower income,
uninsured, minority groups, poorly educated,
and Medicaid insured) are likely to use
emergency departments as their primary
source of health care. Although patients may
experience low priority and long waits in busy
emergency departments when they present
with non-emergent conditions, the availability
of care (24 hour services, no appointments)
and the comprehensiveness of care (radiol-
ogy, lab work, etc. all in one place) in hospital
emergency departments make them an
attractive source of care in spite of the
inconvenience (Baker et al., 1994).
The underlying reasons for using emer-
gency departments for non-emergency care
are complex, and frequently poorly under-
stood. In addition to a lack of family financial
resources, research also indicates that other
factors contribute to use of emergency
departments, such as family structures (i.e.,
single parent families vs. married couples),
and region of residence (Halfon et al., 1996).
A large body of research indicates that
emergency departments fill a gap in services
by providing treatment, medical advice, and
parent reassurance because there is a lack of
access to primary care physicians (Mayefsky,
El-Shinaway & Kelleher, 1991; Feigelman et
al., 1990).
Because of increased use of emergency
departments for non-emergent care, manyhospitals are struggling to continue to
provide non-emergent care in the emergency
department. In the past, many hospitals and
providers, especially those in economically
depressed areas, counted on commercial
insurance and government reimbursement to
supplement their charity care and, thereby,
provide more services to uninsured patients
(Cunningham, Grossman, St. Peter, & Lesser,
1999; MacPherson, 1996; French, 1995). As
commercial and governmental insurance plans
negotiate lower rates, available resources to
support episodic emergency department care
have significantly diminished (MacPherson,
1996; French, 1995).
In an attempt to understand the underly-
ing reasons for non-emergent emergency
department use, this research examines the
socio-demographic and health service use
patterns of two samples of children in Dallas,
Texas. It describes and contrasts the socio-
demographic and health service use patterns
of a sample of patients from the predominant
"safety-net" pediatric provider in the area
(Children's Medical Center of Dallas) with
those of a random sample of Dallas metropoli-
tan area children, the hospital's primary
catchment area. It was hypothesized that
vulnerable children are still likely to rely on
"safety-net" emergency departments as their
regular source of medical care due to socio-
economic reasons and lack of access to
primary care, even in this era of health care
reform and broadening federal/state medical
insurance programs.
MATERIALS & METHODS
Children 's Medical Center of Dallas
Children's Medical Center of Dallas
(CMCD) is a 322-bed pediatric hospital in55
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Roy, Lonnie C.; Eve, Susan Brown & Ahmad, Naveed. Pediatric Emergency Departments: "Safety-Net" Providers for Vulnerable Children, article, 2003; [Lubbock, Texas]. (https://digital.library.unt.edu/ark:/67531/metadc485930/m1/2/: accessed March 30, 2024), University of North Texas Libraries, UNT Digital Library, https://digital.library.unt.edu; crediting UNT College of Public Affairs and Community Service.