Emergency Department Utilization Following Enrollment in a Health Care Access Program for the Uninsured, New York City 2019–2020

Abstract: This study evaluated the short-term impact of NYC Care, a program connecting uninsured New York City residents to primary care and other health services at no or low cost, on post-enrollment utilization of emergency departments (EDs) from July 2019 to March 2020. We conducted a retrospective cohort study using hospital discharge records of 13,619 adult NYC Care participants. We matched early-enrolled (treatment group) and subsequently enrolled participants (comparison group) using full matching on propensity score and estimated average treatment effect via g-computation. NYC Care participation was associated with increased risk and rate of ED visits in the first two months post-enrollment. However, there was no difference in ED utilization overall. Our findings suggest that NYC Care did not increase ED utilization in the study period despite low out-of-pocket costs to access health services. The initial spike in ED visits may indicate missed opportunities to further help participants navigate the health system.