Emergency Room Use and Type of Insurance

One theory about high emergency room use is that it is prompted by people who don’t have health insurance, don’t get enough regular care or don’t want to pay for it, and go to the emergency room either because they think they won’t have to pay or they have a health need that became more urgent.  Since the reform law is supposed to reduce, and to some extent has reduced, the number of uninsured, it should also decrease ER use, under this theory.  So far the evidence is that it hasn’t.  A new piece of research that looks at ER utilization by insurance type, but is based on data on about 2.2 million ER visits in 2008, before the reform law was passed, may explain why it isn’t working as the theory predicted.  (AJMC Article)  The authors are particularly interested in whether the use of the emergency room was really because of an emergency, or was for a health need that could have been handled in another outpatient setting.  They believed that getting insurance might lessen the number of ER visits for non-emergent needs.  Interestingly, the uninsured represented about 15% of the population but accounted for 17% of ER trips, whereas Medicare and Medicaid enrollees had a much higher proportion of ER visits than the percent of the population they represent.  On the other hand, the uninsured were more likely to use the ER for unnecessary purposes than were commercially-insured persons.  Even more interestingly, counties with a higher ratio of primary care physicians to population actually had more non-emergent ER visits.  Since most of the decline in the uninsured has been due to an increase in Medicaid enrollment, it is likely, as the early research suggests, that we actually will see more ER use and more of it for non-emergent reasons.  Another theory behind the reform law down in flames.