In cases of emergency

ambulanceEmergency room myths are one of my pet peeves.  Here are a few that simply will not die:

Myth #1: When people get health insurance, they will go to a regular doctor and NOT the emergency room.

Truth: When people get health insurance, they will get care wherever they want to and lots of them will go to the emergency room.  Case studies:

  • When Massachusetts did Romney Care in 2006, the frequency of emergency room visits went UP, not down.
  • When Oregon gave people Medicaid by lottery, the winners used the emergency room MORE, not less than the uninsured losers.

Myth #2: People who have no health insurance crowd the emergency room because they have nowhere else to go.

Truth: The percentage of uninsured children who have an ER visit (14%) is roughly the same as for privately insured children (15%).  Uninsured adults are somewhat more likely to have an ER visit than a privately insured adult:  21% versus 16%.  However, in absolute number of visits, privately insured people win hands down.  In 2011, privately insured people had 34.3 million visits; uninsured people had 20 million visits.    So for every three uninsured people visiting, there were five insured people visiting.

So who is crowding the ER?  Privately insured people!

Myth #3: We would spend a lot less money if people would go to a doctor’s office, rather than the emergency room.

Truth: We already spend more than four times as much on medical office-based services than we do on emergency room care.  In 2011, ER costs in the United States were $52 million; medical office costs were $232 million.

Compared to the $2.7 trillion spent on health care that year, $52 million for ER care is decimal dust.  It is 0.001926%, or roughly $1.90 out of every $1,000 spent.

Saving $52 million is obviously worthwhile and perhaps even possible.  The majority (70%) of ER visits are deemed “avoidable”, meaning that they do not require immediate medical attention.  In theory, we could save tens of millions of dollars if privately insured people used the ER less for their hang nails and twisted ankles.  In practice, we would increase our expense for office visits and eat up at least some of these savings.  Meanwhile, the hospital’s ER overhead would not change; it simply would be spread over fewer patients.

It would be unpopular to tell privately insured (i.e. mostly middle class) people that they are the ER abusers.  Pointing the finger at uninsured and Medicaid members is much more palatable, and also allows policymakers to do something even if it is not aimed at the real problem.

Not to worry – these myths come up every year like crocuses but a lot less pretty.  Tune in next year for different data, same story.

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2 Responses to In cases of emergency

  1. Bob Kohnle says:

    Dear Linda,
    Thank you for this thought provoking article. My question would be, are there more people that have insurance than do not? would this not need to be accounted for? applying this to both ER and Office visits, there is a significantly larger number of insured seeking care. would looking at the number of visit per population size make any difference? also cost per treatment render ie ER vs Office visit would be more descriptive rather than total amount of cost?

    Thank you!

    Bob

    • Linda Riddell says:

      Bob, yes there are more people with insurance than without. You are absolutely correct that the visit rate is relevant and the cost per visit. I cite the total cost of emergency care to highlight that in itself, it is not a huge cost driver. There are far more productive focal points for management efforts than emergency care!