Excessive emergency room use is said to be symptomatic of difficulty accessing other sources of care, such as a regular primary care physician. The uninsured and Medicaid recipients are said to be particularly frequent users of ERs, often not with real emergencies. A report from the Center for Studying Health System Change looks at Medicaid recipients’ ER use. (CSHSC Brief) The research finds that while Medicaid beneficiaries use the ER at about twice the rate of privately insured persons, they have only a slightly higher rate of use for non-urgent reasons. But they do have a significantly higher rate of use for only sort-of urgent reasons. Some of the greater use may reflect access difficulties, a sicker population, or in some cases, abuse of the system or lack of information and good judgement about how to use health care.
Hospitals sometimes complain about how much ER use costs them, but increasingly they are advertising their ER wait times on billboards you see on freeways on any major city and hospital systems are building new, often stand-alone ERs. They can’t be losing that much money on them, in fact, given the high charges for ER visits, they are probably doing just fine on them. And patients undoubtedly go to ERs when they don’t have to, partly because they may find it more convenient. The solution may be to have facilities similar to retail clinics that can handle more urgent problems and coexist with ERs. If these centers were staffed by lower-cost providers like physician assistants and nurse practitioners, the cost would be lower, quality would not suffer and patient satisfaction would be fine. ERs could be saved for true emergencies. This may actually be a cheaper solution than trying to always push patients to primary care physicians.