Emergency Room Use

The Journal of the American Medical Association published a study looking at statistics on emergency room use in the decade from 1997-2007.  The data were based on national health survey results.  (JAMA Article) ER visits in this time frame went from about 95 million a year to 117 million, about double what might be expected from population growth.  The number of emergency rooms decreased from 4114 t0 3925, undoubtedly creating great stress on those remaining.

The vast majority of the increase in visits was attributable to adults aged 18 to 64.  Although Medicare beneficiaries are often believed to be heavy users of the ER because of their overall health status, their visit rates did not change.  And almost all the change among adults was in those enrolled in Medicaid, who dramatically increased ER usage.   The use of ER by privately insured and uninsured persons was basically unchanged.  The authors suggest that perhaps Medicaid use is up because of difficulty finding primary care.  If this is true it may be because reimbursement is so low for Medicaid.

A more likely explanation is the characteristics of this demographic, who tend to be poorly educated and to exercise bad judgment in many areas of their lives.  Community health centers are widely and easily available in the areas of the country from which Medicaid enrollment is drawn.  Over half of Medicaid beneficiaries are in managed care plans, which have every incentive to get people to primary care and make strenuous efforts to do so.  Unfortunately many of these enrollees take little care of their health.  The question should be what do we need to do to encourage people to adopt appropriate health and health care seeking behaviors.  Medicaid benefit design needs to be changed to stop facilitating poor behavior.