The uninsured consumer and hospital choice: an assessment of emergency department utilization.

The term "choice" has played an important role in the ongoing debate over health care reform in the United States. One of the major assumptions underlying reform efforts is that affordability drives consumers' choice of health care providers, particularly for the uninsured. In the state of Maryland, the issue of affordability is addressed by an "all-payor" system. In such a scenario, where enhanced choice opportunities are available for the uninsured, such consumers seem to be making choices which lead to the use of hospitals other than those which would be predicted based upon convenience or closeness of location alone.