So it turns out that the fastest growing group of people utilizing emergency rooms consists of middle class patients with health insurance. Not the uninsured population that we all tend to assume are overcrowding our emergency rooms because they lack access to a primary care physician. In fact, the percentage of uninsured patients using the ER actually dropped when data from 2003 – 2004 (14.5%) is compared with 1996 – 1997 (15.5%). The percentage of higher income, insured patients using the ER increased from 21.9% to 29% in that same time period.
This article surprised me, because I had assumed that emergency room overcrowding was directly related to the ever-increasing number of uninsured people in the US. It makes sense that if people don’t have insurance they may put off seeing a doctor as long as possible, and end up with complications that require emergency care. But it turns out that people are using the ER for the convenience factor. ERs are ever-open, treat (or at least examine) everyone who comes through their doors, and can offer a wide range of tests, procedures, and medical services. And they’re attached to hospitals, so if an admission is necessary, it’s a pretty easy process.
Overcrowding in emergency rooms is a serious problem in the US health care system. Our assumptions that it’s related to the lack of health insurance seems to be wrong, but it’s still an issue that needs to be addressed. One solution might be to have more urgent care centers, and have them be attached – or very near – to hospitals. Urgent care facilities can handle many of the lesser injuries and illnesses, freeing up ER space and staff to treat the most gravely ill. Treatment at urgent care facilities is generally less expensive than it would be in an ER, simply because at urgent care the overhead is lower. If everyone with injuries or illnesses that were not life or limb threatening were to utilize urgent care centers instead of the ER, the overcrowding problem in emergency departments – the places designed to save lives – would be much less of an issue.
So why don’t people use urgent care centers instead of the ER? I can only speak for myself here, but I think part of the problem might be location. I can tell you where three hospitals – and thus three emergency rooms – are within 20 minutes of our home in Broomfield Colorado (and if we were to go a few miles down the road to Denver, there are several more). But I don’t know the location of any urgent care facilities near our home. So in the event of a serious illness or injury, my first reaction would probably be to head for an emergency room. If hospitals were to set up urgent care centers near their emergency rooms, it would encourage patients to self-triage and choose the less-expensive urgent care in many cases. Since insured patients are obviously using the ER in large numbers, it would benefit health insurance carriers to promote the use of urgent care centers for their insureds, and maybe even to sponsor the creation of new centers.