The Eternal Life of Bad Ideas

Bad ideas often have long and successful careers.  Plenty of people still think autism is caused by vaccines despite a deluge of evidence to the contrary.  The eternal_life_bad_ideasworst are ideas that gain urban legend status and no one beats them down with solid evidence.  The legend of emergency rooms is exactly one of these. 

The ER legend goes like this:

  • Uninsured people flock the ER because they cannot be turned away.
  • Emergency room care costs a lot compared to a doctor’s office.
  • If we could get people away from the emergency room, we would save besquillions of dollars.

Like all good legends, it has a grain of truth.  In this case, the grain of truth is then smothered.

Point #1: Uninsured people crowd emergency rooms

Uninsured people are having fewer ER visits than ever:  From 2012 to 2013, the total number of emergency room visits went down nationwide by 16%.  Uninsured people’s visits went down 23%, towering over privately insured people’s puny nine percent decrease.  (Source: Health Care Utilization Program HCUPNet.)

Bottom line: there are more insured people (840,530 in 2013) crowding the ER than there are uninsured people (669,519 in 20313). 

Point #2: ER care costs more than a doctor’s office

Here is one grain of truth in the ER legend.  Yes, an average ER visit in the U.S. costs $1,400 and that’s just the hospital’s fee.  A doctor’s office visit can come in at $89.  It does not follow, however, that we could avoid more than $1,200 in charges for every non-emergency that shows up in the ER.

First of all, even experts (let alone patients) have trouble telling the difference between true emergencies and minor incidents.  Patients who do go to the ER for sore throats go for the 24/7 convenience, which a doctor’s office cannot match.

Interestingly, ER charges are roughly in line with their share of outpatient care delivered.

Bottom line: Total spending on ER care is not out of line considering the care it delivers. 

Point #3: We could save tons of money by keeping people out of the ER.

At nine percent of all health care spending, ER care takes up about $75 billion.  We cannot save all of this money, because there are after all emergencies. And, arguably, we would not save money by sending non-emergencies (assuming we could discern them) to the doctor’s office – the ER’s operating costs would simply be spread over fewer patients.

On top of that, there is another reason that ERs will remain wide open to all comers: about half of all hospital admissions are patients who came in through the emergency room.  Hospitals would be cutting off a steady stream of inpatient stays (and charges) by having “narrower” ER doors.

Bottom line: Even if we could send non-emergencies somewhere else, we would still have to keep ERs open.  Besides, hospitals love them as a source of patients. 

Will this bad idea ever die?  You can help move it toward the grave – when someone starts ranting the ER legend, you can say “I read somewhere . .  .”

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