The Association of Insurance Type with Use of Emergency Care in New York

Background Avoidable emergency department (ED) visits—non-emergent care that could be managed in primary care—remain strikingly common, with an estimated 40% of ED visits classified as avoidable in 2024. These visits contribute to ED overcrowding, higher costs, workforce strain, and longer wait times that can worsen outcomes for time-sensitive conditions. Barriers to timely primary care, which vary by insurance type, may drive these patterns of avoidable ED use. In this study, we examined the association between insurance type and avoidable ED visits in the State of New York, hypothesizing that such visits are more common among patients with public insurance or who are uninsured than among those with private coverage. Methods We analyzed de-identified 2022 inpatient discharge data from Health Data New York’s Statewide Planning and Research Cooperative Systems (SPARCS) dataset, “Hospital Inpatient Discharges (SPARCS De-Identified): 2022,” (n=430,772), which includes hospital discharge information (e.g., diagnoses, services, charges) across New York State’s districts, ethnicities, and age groups. Key variables included Avoidable ED visits, which were based on severity of illness (minor = avoidable vs. non-minor = non-avoidable), and the predictor, insurance provider type (private, public, and uninsured [self-pay/miscellaneous/other]). Using SPSS, we calculated multinomial logistic regressions to examine the associations between patient demographics and admission type. Results We found that publicly insured patients had 14% lower odds of avoidable ED visits compared to privately insured patients (Adjusted Odds Ratio [AOR] = 0.86; 95% Confidence Interval [CI]: 0.84–0.87; p<.001). Uninsured patients classified as miscellaneous or other also were significantly less likely than those who are privately insured to engage in an avoidable ED visit (AOR = 0.88; 95% CI: 0.81–0.95; p<.001). These findings suggest that public insurance holders and the uninsured may defer care until there is an emergency or they can no longer defer issues normally addressable through preventive and primary care. Conclusion Examining avoidable ED visits can inform targeted policy reforms and technological interventions to reduce emergency department overcrowding, mitigate workforce burnout, and improve patient health outcomes. Our findings suggest that avoidable ED use is most common among privately insured patients, whereas publicly insured patients have lower odds of avoidable ED use. This pattern may reflect differences in care-seeking behavior and access to primary care, whereby publicly insured and uninsured individuals may defer care until conditions become severe and no longer avoidable. These findings underscore the importance of continuity of care and expanded safety net services.