Date of Award


Degree Name

Doctor of Philosophy


Public Affairs and Administration

First Advisor

Dr. Matthew S. Mingus

Second Advisor

Dr. Victoria Ross

Third Advisor

Dr. Chul Young-Roh


This study analyzes one component of the health care safety net to determine whether or not being enrolled in a free or low-cost primary care physician access program subsequently affects emergency room utilization by uninsured adults ages 18 through 64. Those individual decisions are analyzed from both public goods and rational choice schemas. Additionally, physician access programs of different formats (a low-cost physician referral program and a freewalk-in clinic) are analyzed and compared for relative effectiveness. The study is a quantitative analysis of more than 40,000 individual patient records rather than relying on qualitative patient recall or on analyzing broad community trends. An Intensity of Use Indicator (IUI) was developed in the course of this study to provide a summarizing number for tracking individual and group ED utilization trends. The IUI should prove useful to hospital and other not-for-profit organizations concerned with tracking cost effectiveness of programs for uninsured adults.

Access Setting

Dissertation-Open Access