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Accessing Acute Care and Avoiding the ER

By September 17, 2010Commentary

Emergency room visits are frequently pinpointed as a major source of inappropriate utilization of health resources and of high spending.  Health Affairs carries several studies addressing the issue of where people get acute care and how much of that acute care is received in emergency rooms.  The first piece of research, based on various national surveys, discusses where Americans receive acute care.   There are about 354 million annual visits for acute care.  Of those, 42% are with the patient’s personal physician, 28% are in emergency rooms, 20% are with specialists and 7% are at outpatient departments.  The authors posit that it would be best if as much acute care as possible was with the patient’s primary care doctor, for reasons of coordination of care as well as cost and they suggest policy approaches to encourage that result.  They are dismissive of alternatives such as retail or workplace clinics or urgent care centers.   (Health Affairs Article)

The next study, also based on survey data, examines emergency room visits to determine how many might be handled in other settings.  Basically the authors looked at what conditions were treated in the emergency room, during daytime hours when alternative sites such as retail clinics or urgent care centers were likely to be open, that could have been treated at those alternative sites.  They estimated that around 14-27% of emergency room visits could have been handled by the retail clinics or urgent care centers, saving at least $4.4 billion and potentially much more, in addition to unburdening emergency rooms.  Unlike the prior study, these researchers did not seem to believe that the alternative sites would provide lesser quality.  (HA Article)

Finally, the third piece of research sought to understand if imposing copayments for non-emergency use of the ED might deter some of the inappropriate use.  Using survey data and a sort of natural experiment that occurred when some state Medicaid programs added copayments for emergency room visits which could have been treated at other sites, the researchers found that the copayments did not appear to deter inappropriate use.  The copayments, however, were very nominal even for the relatively poorer Medicaid population.  Other research has suggested that meaningful copayments will deter ED use.  (HA Copay Article)

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