Contrary to widely held belief, people with private health insurance--not the uninsured--were the main drivers of a 16% rise in emergency room visits between 1996-97 and 2000-01, according to a study released today by the Center for Studying Health System Change.
Difficulties getting an appointment to see a physician and a loosening of managed care constraints were the chief causes of the steep rise in ER visits, which reached 108 million a year in 2000 and 2001, the Washington, D.C.-based organization says.
ER visits by the privately insured rose 24% in the four-year period, compared with a 10% rise for Medicare beneficiaries, a 10% rise for self-pay or no-charge (typically uninsured) patients, and no change for Medicaid beneficiaries, the study reports.
Further, HSC finds that uninsured people's 10% rise in ER use was accompanied by a 37% decline in physician office visits in the same period. As a result, one-fourth of all doctor visits by the uninsured in 2000-01 took place in ERs, compared with 17% in 1996-97, the report says.
In contrast, privately insured individuals' visits to physicians' offices rose by 29%, HSC reports.
"Uninsured people clearly are not a major factor in increased crowding at most hospital emergency departments, but uninsured people's growing reliance on emergency care indicates decreased access to other sources of care," says a co-author of the study, Peter Cunningham, a senior health researcher at HSC.
The HSC study also finds that:
- Just under half of ER visits in 2000-01 were either emergent (requiring care within 15 minutes of arrival) or urgent (requiring care within an hour). A little over one-quarter of visits were classified as semiurgent or nonurgent, requiring care within one to 24 hours of arrival, while the remaining quarter were of unknown triage.
- Patients are waiting longer for ER care. The proportion of emergency department patients who waited more than half an hour rose from 36% in 1999 to 45% in 2001. Further, the uninsured and Medicaid patients wait longer than privately insured and Medicare patients do.
- Among ER patients who waited more than an hour for treatment, only 28% rated the thoroughness of their exam as very good or excellent, and only one-third gave a positive assessment of how well the physician listened to them. In contrast, 66% of patients who waited 15 minutes or less gave a positive assessment of the exam and physician.