Most emergency department patients lack access to other sources of care

Many emergency department patients are there because they do not have any place else to go for medical services, according to data released May 22 by the Centers for Disease Control and Prevention’s National Center for Health Statistics.

This fact and the ongoing economic funk may help explain why ED use has shifted upward but physician office visits have decreased.

Researchers analyzed data on thousands of participants ages 18-64 in the National Health Interview Survey who visited an emergency department at least once in the 12 months before January 2011 through June 2011, but were not admitted to a hospital. Children, the elderly and those ill enough to need inpatient care — about 25% of ED patients — were not included.

When asked to explain why they visited the emergency department, nearly 80% said they lacked access to other health care professionals. Forty-eight percent said their physician’s office was closed, and more than 46% had no other place to go. For almost 46%, the emergency department was the closest source of care. Respondents could select multiple reasons for their ED visit.

Trend data on the subject are not available, although other data suggest that ED use went up during the economic downturn as physician offices visits declined. According to the CDC, the number of ED visits grew to 136 million in 2009 from fewer than 124 million in 2008. Data from the IMS Institute for Healthcare Informatics found that visits to physician offices decreased 4.7% in 2011 after a drop of 4.2% in 2010. In the NCHS survey, almost 62% of patients without insurance receiving care in the ED said they were there because they had no other place to go. This was true for 39% of patients with private insurance and 49% of those with public coverage.

Reducing ED use has become a focus of efforts to reduce health care costs, with some public and private plans refusing or reducing payments for the service. That move has been opposed by medical societies, including the American Medical Association and the American College of Emergency Physicians.

“Patients should never be in the position of having to self-diagnose their own medical conditions out of fear their health plans won’t pay,” said David Seaberg, MD, ACEP’s president.

Advocates argue that the majority of ED visits are necessary and that it’s not always clear before a visit that a problem is actually minor. Of those in the NCHS survey, 55% went to an ED because they thought only a hospital could help, and nearly 43% said the problem was too serious for a doctor’s office.

“There’s no validated approach to measure emergency department overuse,” said Robert A. Lowe, MD, MPH, an emergency physician and senior scholar at the Center for Policy and Research in Emergency Medicine at Oregon Health & Science University in Portland. “Patients feel the emergency department is the place they need to be. The frequent users, in general, are not people who are using the emergency department instead of primary care. They’re sick, and they use a lot of all kinds of health care.”

An ACEP survey of 1,026 adults released May 21 found that 83% had been to an ED as a patient. Of this group, 95% had a usual source of care, and 85% said they probably could not have waited for access.