Date of Award

Winter 2012

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Services Research

Committee Director

Andrew Balas

Committee Member

Qi Harry Zhang

Committee Member

Carolyn Rutledge


The purpose of this research is to examine the factors affecting non-urgent utilization of emergency department (ED) services by individuals with "universal" healthcare using the Behavioral Model of Health Services Use. Since Air Force Medical Service beneficiaries have free and unlimited use of the full-range of healthcare services, they are ideally suited for this study. The findings of this research may also apply to other populations with free or low-cost access to healthcare (i.e., universal or single-payer healthcare). Using secondary data extracted from the Air Force Medical Service's electronic health record system at several military hospitals, this study will present descriptive and inferential statistics on person-based ED and primary care utilization of spouses of active duty military. This study is important because a significant proportion of patients present to the ED with medical problems that are classified as non-urgent and could safely be treated by a primary care provider. In particular, the costs associated with non-urgent use of ED services are very high; patients with non-urgent ED use impose a substantial strain on the efficiency of the ED; and increasingly, patient satisfaction has become more important since it is considered a primary indicator of quality of care. While this problem exists both in the military and civilian sectors, the non-monetary predictors of presenting to the ED with non-urgent medical problems have not been well studied for patients with "universal" healthcare or in the context of the Air Force Medical Service. The results of this research are likely to provide hospital leadership with insights to aid them in making evidence-based decisions aimed at reducing non-urgent (unnecessary) use of ED services. Finally, the most significant predictor of non-urgent ED use is related to SES and age category. That is, spouses of enlisted military members with non-urgent ED use are 2.855 times more likely to be under 40 years of age. Therefore, the findings of this study provide a starting point and would be magnified in value once attitudinal factors of patients are incorporated.