A new International Journal of Health Services report found that emergency departments (ED) delivered 47.7% of all medical care in the U.S. between 1996 and 2010.
The researchers of “Trends in the Contribution of Emergency Departments to the Provision of Health Care in the USA” said EDs are a “major source of medical care,” especially for vulnerable populations.
- They found ED visits increased by nearly 44% over the 14 years studied. The researchers said nearly 130 million ED visits, 101 million outpatient visits and 39 million inpatient visits happened in the final year of the study.
While primary care, managed care and accountable care organizations are often promoted as ways to improve healthcare, the researchers said EDs have “largely not been given consideration.” Given the high percentage of ED services, they said emergency care should be part of healthcare policy discussions and population health efforts.
The study compared care received in EDs to outpatient and inpatient services using National Ambulatory Medical Care Survey and National Hospital Discharge Survey databases.
The researchers found that specific patient groups were more likely to use EDs than other groups. For instance, African-American patients were significantly more likely to visit EDs than patients in other racial groups. African-Americans used EDs 54% of the time in 2010 and African-Americans at urban hospitals used EDs 59% of the time, according to the study.
The researchers also found that the west (56%) and south (54%) had higher ED rates than other sections, including the northeast (39%).
David Marcozzi, an associate professor at the University of Maryland School of Medicine's Department of Emergency Medicine and co-director of the UMSOM Program in Health Disparities and Population Health, said he was “stunned by the results.” He said the findings show that EDs are “critical to our nation’s healthcare delivery system.”
The study looked at ED usage up to 2010, which was before the Affordable Care Act (ACA). ED usage numbers have likely changed since then. The ACA required nearly all Americans have health insurance and there are 20.5 million fewer uninsured Americans now compared to 2010. Only about 9% of Americans are uninsured now. More people with coverage likely means fewer people using EDs for their basic healthcare.
Plus, payers and the CMS have created policies that look to move in-patient and ED care away from hospitals and into outpatient facilities, urgent care centers and retail clinics. In fact, Anthem recently implemented a policy in which the insurer won’t pay for ED visits that it deems unnecessary in some states.
ED usage has likely decreased since the final year of the study. However, that doesn't take away the important role that EDs are playing in healthcare, especially for some patient populations.