Integrated Healthcare Delivery and Health Insurance Models for Studying Emergency Department Utilization

An important healthcare problem in the United States of America is that of emergency department overcrowding. A plausible explanation for such overcrowding is that the lack of access to primary care, which may be influenced by one’s insurance status, leads to greater use of emergency departments. Additionally, it has been suggested that the inappropriate use of emergency departments, along with the phenomenon of cost-shifting, results in higher healthcare costs in the form of higher insurance premiums. Higher premiums may in turn influence one’s insurance status. To study these relationships, we develop a system dynamics model that captures key interactions between population health state progression, healthcare economics, and population health insurance status. Two interventions are investigated: government subsidies to individuals for purchasing health insurance, and safety-net clinic capacity. We also explore the sensitivity of emergency department utilization to employment rate and population susceptibility to illness.