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Insured Americans Drive Surge in Hospital Emergency Department Visits
Study Counters Perception that Uninsured People are Major Cause of Crowded EDs
FURTHER INFORMATION, CONTACT:
ASHINGTON, D.C.—Contrary to beliefs that uninsured Americans are a major cause of increased emergency department crowding, insured Americans accounted for most of the 16 percent rise in hospital emergency room visits between 1996-97 and 2000-01, according to a national study released today by the Center for Studying Health System Change (HSC).
"Across the country, emergency departments are crowded and seeing a lot more patients, and most of the increase, surprisingly, is from insured people, not the uninsured," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded exclusively by The Robert Wood Johnson Foundation.
U.S. hospital emergency department (ED) visits increased to almost 108 million annually in 2000 and 2001, an increase of about 16 percent from 1996-97. Emergency department visits between 1996-97 and 2000-01 increased 24 percent for privately insured people, 10 percent for Medicare beneficiaries, 10 percent for self-pay or no-charge—typically uninsured—patients but were unchanged for Medicaid beneficiaries, according to the study based on data from the Centers for Disease Control and Preventions (CDC) National Hospital Ambulatory Medical Care Survey.
Together, privately insured and Medicare beneficiaries accounted for almost two-thirds of the overall increase in ED visits. In contrast, self-pay or no-charge patients accounted for about 11 percent of the increase in ED visits. People with other sources of coverage—workers compensation, for example—or unknown coverage accounted for the remaining increase.
For privately insured people, the 24 percent increase in ED visits paralleled an across-the-board increase in ambulatory care use, including a 29 percent increase in physician office visits between 1996-97 and 2000-01, the study found. In contrast, for uninsured people, the 10 percent increase in ED visits was accompanied by a 37 percent decrease in physician office visits, resulting in uninsured people relying on emergency departments for an even greater part of their medical care. One-fourth of all doctor visits by the uninsured now take place in emergency departments, compared with 17 percent in 1996-97.
"Uninsured people clearly are not a major factor in increased crowding at most hospital emergency departments, but uninsured peoples growing reliance on emergency care indicates decreased access to other sources of care, including physicians offices. Getting medical care outside of the emergency department is definitely becoming more difficult for uninsured people," said HSC Senior Health Researcher Peter Cunningham, Ph.D., who co-authored the study with HSC Research Assistant Jessica May.
The studys findings are detailed in a new HSC Issue Brief—Insured Americans Drive Surge in Emergency Department Use. In addition to the CDC survey, the study also reports findings from HSCs Community Tracking Study Household Survey, a nationally representative survey involving about 60,000 people
Other key findings include:
Capacity constraints experienced by office-based physicians, combined with a loosening of managed care restrictions, may be contributing to increases in ED visits. Other HSC research shows that more patients are having problems making timely appointments with their doctors. And, more physicians report having inadequate time with their patients and more are closing their practices to some new patients.
"Emergency departments are open 24 hours a day, seven days a week—no appointment needed. If patients cant get in to see their doctor, they may view emergency departments as more convenient sources of primary care than their regular physicians," Cunningham said.
Physicians also may be responding to increased workload by referring patients to EDs with greater frequency, and declines in risk contracting and capitation mean they no longer have financial disincentives to do so. In some cases, increased utilization may be associated with physicians practicing defensive medicine by sending potentially risky patients to EDs instead of providing care in their offices.
Gail Shearer, director of health policy analysis, Consumers Union, www.consumer.org
Carmela Coyle, senior vice president for policy, American Hospital Association, www.aha.org
J. Brian Hancock, M.D., president, American College of Emergency Physicians, www.acep.org
The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely insights on the nations changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded exclusively by The Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.