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Privately Insured Patient Use of ERs

By January 8, 2014Commentary

Emergency rooms tend to be a costly setting for receiving care and their use is also a factor in uncoordinated care.  Better primary care is believed to be a way to deter inappropriate ER use, and of course financial incentives are used by private insurers to encourage patients to think before they go to an ER.  A new brief from the Center for Studying Health System Change looks at factors in use of the ER.   (CSHSC Brief)   The brief is based on survey responses and the headline summary of the brief is that people use the ER because they really believe they have an emergency need.  According to the results, half of respondents going to the ER did so because they thought their medical problem was an emergency.  Well of course they did, so what?  Only 7% said they went in part because of convenience, but again, who is going to admit that?  About 25% said they contacted their physician and were told to go to the ER.  But only half of all people going to the ER even tried to call their doctor first.  Another 20% called 911 and 17% called or went to urgent care first.  People who did contact their physician first were far less likely to be treated in the ER, so it is obvious that policy efforts should be devoted to ensuring that people call their physicians first with any care need and that physicians have staff available who can handle these calls.  Many users of the ER appear to be the classic group with a set of poor health behaviors and multiple chronic conditions.  This group may need strong incentives to avoid inappropriate ER use.  Interestingly, many in this subgroup and others tend to believe that care quality is higher in ERs, which is dubious.  So they are likely to go to ERs thinking they will get faster and better attention.

The brief has limited value because its data is solely based on surveys of one group–autoworkers and spouses, which is hardly representative of the working adult population as a whole and which is also not geographically dispersed.  In addition, we saw in the research on the Oregon Medicaid lottery just how unreliable self-reported survey data is.  This group normally puts out better research than this weak effort.

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