Access to Care: Access Is a Prerequisite to Quality

Access to care is a multidimensional concept of key importance when analyzing patterns of emergency department (ED) use. Many of the individual social determinants that exacerbate challenges to healthcare access are addressed elsewhere in this book. This chapter focuses on the role of the ED within the broader healthcare system—both how the availability of community and health system resources may influence individuals’ choice to seek ED care, and also impact their ability to access other sources of care before or after an ED visit. Emergency physicians have an important role in measuring, monitoring, and protecting access to care, particularly for the most vulnerable populations including those who are unhoused, poor, and people of color. Rigorous research done by emergency physicians related to patient access has led to important policy changes – from early studies of “patient dumping” that led to EMTALA legislation, to the use of simulated patient methodology, which employs researchers posing as patients to estimate local access to health care based on insurance status and other characteristics. We discuss the emerging role that emergency medicine needs to embrace via collaborations to improve transitions of care both into and out of the ED, so as to reduce health care fragmentation and wasteful spending, and improve access and quality for all our patients.