Policy/Biz

Visits To ER Rose Following Recession: What Role Do Emergency Rooms Play In The Health Care System?

emergency room
Emergency room visits by children, teens, and young adults in California increased following the recession. Reuters

While many people hope that increasing insurance coverage through the Affordable Care Act will lead to a decrease in emergency room visits, access to Medicaid may actually be linked to an increased use of emergency services among adults. And what about children? An analysis of emergency room visits by children, teens, and young adults in California found that rates increased across the uninsured as well as the insured, no matter their group. "Shifts in insurance (from private and no insurance to Medicaid) during the recession (December 2007-June 2009) likely influenced the trends during this time," wrote the authors in their conclusion.

History of Emergency Rooms

The emergency room is only a century-old concept. Around 1911, Dr. William O. Roberts started the first ever "accident service" with four medical students at Louisville City Hospital. They offered around-the-clock treatment to anyone in need of immediate care. Shortly thereafter in 1932, Dr. R. Arnold Griswold revolutionized the service in the same hospital by establishing Louisville's first blood bank. More importantly, he created the first ambulance service when he trained police officers in emergency care and then equipped police cars and fire trucks with necessary medical supplies. Since then, emergency services have continued to evolve.

To understand how ERs play into our current health care system, Dr. Renee Y. Hsia, of UC San Francisco, and her colleagues turned to the California Office of Statewide Health Planning and Development’s Emergency Discharge and Patient Discharge data sets. The team collected and analyzed data of emergency department (ED) visits in acute care hospitals made by people under the age of 18 across California between the years 2005 and 2010. To understand how insurance coverage impacted use, the researchers grouped the visits into four categories: Medicaid, private insurance, uninsured, and other.

Upon analysis, the researchers discovered a general rising trend. Specifically, the number of visits increased from 2.5 million in 2005 to 2.8 million in 2010, a swell of 11 percent. The distribution across payer groups changed significantly between 2005 and 2010, with Medicaid accounting for a larger portion of total visits over time: about 44 percent of the total, after adjusting for pediatric population shifts during the study period. However, the overall rate of emergency room use increased across all insurance groups. The uninsured displayed the fastest increase in visit rates, from 202 to 248 visits per every 1000 (a 22.7 percent hike), followed by those privately insured whose visits rose from 176 to 202 visits per every 1000 (a 15.0 percent increase). Emergency room rates for those covered under Medicaid showed the slowest growth, while remaining the highest in absolute terms: from 341 to 366 visits per 1000 (7.4 percent).

"These findings suggest that the drivers for ED use differ significantly between youths and adults and that policies regarding insurance expansion may also have varying effects,” wrote the researchers at the conclusion of their report. They suggest this trend may reflect an increasingly central role of the ER in the U.S. health care system, especially during a period of severe economic recession.

Source: Hsia RY, Nath JB, Baker LC. Emergency Department Visits by Children, Adolescents, and Young Adults in California by Insurance Status, 2005-2010. JAMA. 2014.

Loading...