Because of the continuing rapid growth in health spending, a lot of time and effort has been devoted to finding those sub-segments of spending where there may be inappropriate or avoidable use. One such sub-segment is emergency room use. The number of emergency departments has shrunk in recent years, but overall visits are up. ER visits tend to be costly and there are concerns about the quality and continuity of care resulting from ER use. A recent Data Brief from the National Center for Health Statistics at the CDC gives some detail on emergency room use, based on calendar year 2007. (CDC Brief) About 20% of Americans had at least one ER visit during that year.
Older persons were more likely to have a visit and visit frequency decreased with increasing income. Medicaid beneficiaries were by far the most likely to have used the ER, compared to those with Medicare, private insurance or no insurance. For those under 65, the uninsured were no more likely than those with private insurance to have had at least one ER visit, debunking the notion that just being uninsured leads to ER visits. In addition, persons with and without a usual source of care were equally likely to visit the emergency room. Finally, the number of ER visits deemed to be non-emergent did not vary significantly across those with Medicaid coverage, private insurance and no insurance.
This statistical brief makes it clear that having or not having some form of insurance coverage and having or not having a usual source of care has nothing to do with going to an ER, so providing coverage to more people isn’t likely to reduce ER utilization, in fact, based on the Medicaid expansion, it would likely increase it. The results of the brief are consistent with the Massachusetts experience, where ER use continued to rise after that state’s reform law was passed. The real issue, it appears, is why Medicaid patients, who presumably have access to a regular physician, are such heavy users of ER services.