Original Article
Emergency department utilization among people with disabilities in Korea

https://doi.org/10.1016/j.dhjo.2018.03.001Get rights and content

Abstract

Background

According to prior studies, it is possible to consider the emergency care utilization due to ambulatory care sensitive conditions (ACSCs) as a proxy measure of access to primary care but there was no confirmed study among people with disabilities.

Objective/Hypothesis

We examined overall emergency department (ED) utilization patterns among people with disabilities compared with the general population and estimated factors affecting ED utilization. Additionally, we examined whether there were any differences in ED visits due to ACSCs according to type and severity of disability.

Methods

The nationally representative Korean Health Panel Survey was used. Data from 14,616 individuals who participated in the survey from 2008 to 2012 were analyzed. The frequency and causes of emergency visits were examined between individuals with and without disabilities. A generalized regression model with Poisson distribution was applied to identify factors that affect ED visits.

Results

In 2012, people with disabilities were about two times as likely to visit the ED compared to people without disabilities, and people with external disability represented the largest proportion of people with disabilities. According to generalized linear model, disability was a strong predictor of ED visits, along with lower education level, being elderly, having a chronic disease, and being less healthy. Overall, ED visits due to ACSCs were about three times higher in the disabled group than in the non-disabled group.

Conclusions

Public health authorities should consider strengthening the primary care system to avoid unnecessary and preventable ED utilization among all Korean people, including people with disabilities.

Section snippets

Data source

The data used in this study were obtained from the Korean Health Panel Survey (KHPS). The KHPS is a nationally representative panel survey with a principal aim of providing baseline information about healthcare spending and utilization in Korea.20 The KHPS has been conducted annually in South Korea since 2008 by the Korea Institute for Health and Social Affairs (KIHASA) and the National Health Insurance (NHI) organization, using computer-assisted personal interviewing.20 The study population

General characteristics according to people with and without disabilities

Table 1 shows the general characteristics of the study population from the KHPS data. Regarding socioeconomic characteristics, the disability group was more likely to be male, of older age, and less educated; have a lower household income; and be MA recipients. As for health status and healthcare utilization, the disability group was more likely to have a chronic disease (88.4% in the disabled vs 54.2% in people without disabilities), have taken medications for long time (13.8% vs 10.8%), and

Discussion

Disability is a challenge for both individuals and society. Disabilities can result in additional problems by limiting access to healthcare services.24, 25, 26 The barriers, such as physical barriers, prohibitive costs, and limited availability of services,27 can further influence the health status of people with disabilities, and may eventually lead to worsening socioeconomic conditions and socioeconomic expenses for the society.

In case of the U.S. there has been a growing concern about the

Conclusion

We confirmed that people with disabilities in South Korea visit the ED more frequently than do people without disabilities. These results could be related to access to care, their complex health conditions, or disability itself. In particular, ED visits due to ACSCs was significantly higher among people with disabilities than among people without them, which could be evidence of a system failure in primary care. Health authorities should consider strengthening the primary care system to avoid

Conficts of interest

The authors have no conflicts of interest to declare.

Funding source

This work was supported by the gs1:National Research Foundation of Korea grant funded by the Korea government (MSIP) (No. 2017R1C1B2002663).

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  • 1

    These authors contributed equally as the first authors of this study.

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