After-hours care; Access to care; Primary care; Continuity of care; Nurse Practitioner; Health Maintenance Organization; HMO


Community Health and Preventive Medicine | Health Policy | Health Services Administration | Health Services Research


After-hours care provides timely access to continuity of care for chronic illnesses and episodic care for acute illness. Lack of timely access to primary care services is one of the main drivers of emergency department overuse. Our aim was to examine disparities in access to after-hours care based on race, income, geographic location, type of insurance, and health care setting. We used data from the 2010 Health Tracking Household Survey. Multivariable logistic regression was used to assess disparities in access to after-hours care. We found disparities by type of insurance, geographic location, and type of health care setting. People with Medicaid were less likely than those with private insurance to have access to after-hours care (aOR 0.67, 95% CI, 0.53-0.88). Those in non-metropolitan areas were less likely to have access to after-hours care (aOR 0.73, 95% CI, 0.61-0.89) as compared to those living in large metropolitan areas. In comparison to the Northeast census region, access to after-hours was less likely in the Midwest (aOR 0.60, 95% CI, 0.49-0.73), South (aOR 0.40, 95% CI, 0.33-0.48), and West region (aOR 0.46, 95% CI, 0.37-0.57). We found no evidence of disparities based on sex, race/ethnicity, or income. With the increasing need of after-hours care, policymakers should plan to provide incentives to providers to offer after-hours care.


Kavita Mosalpuria