The overutilization of emergency rooms is often cited as a dangerous symptom of America’s broken healthcare system. But a new Slate article from Zachary Meisel and Jesse Pines offers a rosier picture of emergency room usage, and dispels several pervasive myths. They write that E.R. care represents less than 3 percent of healthcare spending, only 12 percent of E.R. visits are non-urgent, and the majority of E.R. patients are insured U.S. citizens, not uninsured, illegal immigrants. Meisel and Pines also point out that E.R. visits don’t necessarily cost more than primary care visits: “In fact, the marginal cost of treating less acute patients in the ER is lower than paying off-hours primary care doctors, as ERs are already open 24/7 to handle life-threatening emergencies.” Ultimately, Meisel and Pines believe that emergency rooms are functioning as they’re supposed to, as “an always-available resource to alleviate pain, make sure your baby is not truly ill, and patch you up after a nasty fall is vital, even if it turns out that your condition wasn’t as serious as you feared.”[%comments]
Emergency Room Myths
TAGS: healthcare
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@Bill
Life expectancy is a terrible indicator of health care availability. Two major reasons:
1 – ‘Life Expectancy’ is a calculated figure and all countries use different calculations. So if the U.S. is calculating A+B=C, France may be calculating X+Y=C, at which point comparing ‘C’ is useless. (for example, many countries don’t factor in premature/low birthweight babies which are less likely to survive – this artificially increases their life expectancy).
2 – ‘Life Expectancy’ is a calculation that is affected by more than just the quality of health care. Americans may (or may not) have a true lower life expectancy, but much of that is (or would be) caused by lifestyle choices. No matter what a doctor does to help me, if I’m munching nachos 24/7, I’m in big trouble (though enjoying the journey).
All due respect to the authors, but that’s nonsense.
I work in a busy urban ER. Over half of the patient population that comes in and out is nonsense… joint pain for several weeks, stomachaches, mosquito bites, headaches, etc. And that’s not even counting the rest home patients who are literally dropped off at the curb who have a low-grade fever or some minimum-wage twit has dislodged their feeding tube.
Anyone who thinks that an ER is cheaper than a PCP should answer me this: when is the last time an office doctor sent a patient for a full CT scan and cardiac workup because of some heartburn? When was the last time you x-rayed an elbow because of a pimple? How many fussy babies get sent from the pediatrician’s office to have a full throat and rectal exam?
As I said, all due respect, but this report is rubbish.
I haven’t worked in ER’s in years, but I do listen to the local paramedic calls on my scanner, and there is a huge proportion of trivial calls, I’m guessing because it is
a. free
b. much more convenient to have the care come to you than having to go several miles to it.
The Slate article you cited has several comments that I think would be quite germane to the discussion. While this stem of an article focuses on the big picture, the problem is much more complex and decentralized.
Your experience referenced in the previous article about over-utilization of ERs, while perhaps exceptional, is still relevant to the discussion. There are some great details in this topic that should be quite a bit more compelling to an economist, such as:
1. Higher rates paid for ER service by the uninsured, due to likelihood of default.
2. The economic cost to hospitals located in communities with higher populations of indigent and uninsured residents, as opposed to those in generally wealthier areas. And then there’s the question of whether those costs are passed on to other patients and if so, how the costs are ultimately distributed amongst the population — whether the hospital takes on a higher share of public subsidies, charges the uninsured a higher rate, successfully nickel & dimes insurance companies, or blends the above options (or somehow gets more out of insurers and drives up the costs of the insured).
3. The regional economic impact of hospitals closing in marginal or poorer areas because they face the problems previously mentioned. In many cases, we rely on hospitals operated by large non-profit corporations, which sometimes must decide to withdraw management from one underperforming hospital for the benefit of the whole system. It’s then up to the area served to decide whether they will create a tax base to keep the hospital operating or let the market sort it out.
Upon reading this article and those cited within, I was inspired to dig up a couple of stories that I recalled from Tucson, Arizona, where health care providers have created innovative ways to deal with these problems:
http://bit.ly/cIGfZv (very impressive and forthright example of dealing with the problem of under-insured patients over-utilizing facilities).
http://bit.ly/dguQkz (less innovative solution, but still helps to demonstrate the problem and show how the commons still matters in such an issue).
The 12% statistic for non-urgent visits to the emergency department is from the CDC and you can find it on page 3 of the CDC’s report here: http://www.cdc.gov/nchs/data/nhsr/nhsr007.pdf.
Bill, 12% comes from the National Center for Health Statistics branch at the CDC. here is the link:
http://www.cdc.gov/nchs/data/ad/ad386.pdf
Marci you are wrong. I work at an ER too and it sure feels like we deliver a lot of non-urgent care. But we don’t. Study after study has proven this. The majority of increased use of ERs come from primary doctors who are sending their patietns to the ER to get those CTs and cardiac tests.
This is the point of research… to test if commonly held beliefs are real or not.
@Brett
The life argument is simply part of the fact check. But the increased costs to the insured by the uninsured is real.
#10 (Marci Kiser)
And I suppose somehow you know that your experience applies to every ER in the country?