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Myths & Facts |
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Would expanding health coverage ease emergency department overcrowding and reduce spending?
What’s Behind It?
Nationally, emergency department overcrowding is on the rise, and studies have shown that many ED visits are for non-urgent care. Because emergency departments (EDs) are staffed with highly trained health care providers and afford access to an array of diagnostic tools, they are an expensive setting for non-urgent care. The uninsured, who typically have no regular source for primary care, may be more likely than those with coverage to use the ED for non-urgent care. It is sometimes suggested that if more Californians had health coverage, they would make fewer ED visits, which in turn would ease ED overcrowding and reduce health care spending.
The Broader Picture
Emergency department use may actually be declining in California. While California’s population grew 3.4% from 2003 to 2006, emergency room visits have actually decreased slightly. Recent research shows a decline in visits by 4.7% from 2003 to 2005.
Communities with high levels of uninsured and noncitizen residents do not have higher levels of ED use. Contrary to popular belief, communities with high levels of uninsured or immigrant residents generally have lower rates of per-person hospital ED use than other communities, according to a study by the Center for Studying Health System Change.
In California, Medi-Cal enrollees are more likely than others to use the ED. Among all California adults, 15% say that they have used the ED in the past 12 months, compared to 18% of the uninsured and 12% of the privately insured population. In contrast, nearly one in three (31%) Medi-Cal enrollees have used the ED in the past year.
Avoidable trips to the ED are linked more closely with convenience than coverage. According to a recent survey of Californians, many insured patients make avoidable trips to the ED because they lack access to care outside the ED, lack advice from their physician about how to handle a sudden medical condition, or simply lack any alternative. Insured patients associate the ED with easier access to testing and specialists as well as better quality care. Finally, insured Californians with a chronic disease are more likely than those without a chronic illness to use the ED to get convenient care, a needed prescription, or a diagnostic test.
ED use represents a small fraction of total health spending. Nationwide, ED use represents less than 4% of all medical expenses. “Avoidable” ED visits tend to be less intensive than other ED visits and account for only about one in five California ED visits. While reducing non-urgent ED use would ease ED crowding in some locations, it would have very little impact on overall health spending.
The Bottom Line
Use of EDs for non-urgent care is an appropriate concern, but providing more Californians with health coverage will not directly address this issue. Unless significant strides are made in delivering convenient, comprehensive urgent care in less intensive settings, a subset of Californians, both insured and uninsured, will continue to use the ED for non-urgent care.
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