ShareThisA hospital's emergency department -- the ER -- is a place most of us don't want to visit, yet collectively we go about 120 million times a year, some of us a lot more frequently than others.
Only about a quarter of us go even once in a given year.
But the role of the emergency department in our health-care lives varies greatly depending upon our age, our health status and our insurance coverage, or lack of it, among other things, researchers are finding.
Recent reports from the non-profit Robert Wood Johnson Foundation and from federal investigators, give some new insights into what's happening in the roughly 4,600 emergency departments around the country.
Certainly, the wait's not getting any better.
A report prepared by the Government Accountability Office for the U.S. Senate earlier this summer found that in 2006, patients who were classified as "urgent" -- who guidelines say should be seen by medical personnel within a minute -- waited for an average of 28 minutes. Those classified as "emergent" -- to be seen in less than a quarter of an hour -- waited an average of 37 minutes.
Surveys suggest about 2 percent of patients just give up and leave before ever getting a medical evaluation.
For those who stay, the average duration of an ER visit in 2006 was 3 hours, 19 minutes.
So just how seriously ill or injured are these patients? That's not so clear.
Some researchers have found that up to 80 percent of the patients arriving at ERs are not true emergencies, but others conclude that visits for routine care that could be handled in a clinic or doctor's office represent about a quarter of the visits.
On the other hand, only about 15 percent of ER visits in 2006 ended with the patient being admitted or transferred to another hospital.
So who uses the ER most frequently? Babies -- there were 85 visits for every 100 infants under the age of 1 year in 2006; the elderly -- 60 visits for every 100 people over the age of 75; and the homeless -- 84 visits for every 100 people who were homeless for some part of the year.
Yet, those groups represented only about 13 percent of all ER visits. The growth in volume of ER visits, most research suggests, has been driven mainly by more non-elderly, insured, middle-class patients turning to the ER because they either don't have a regular source of primary care or can't get an appointment for a medical situation they think is urgent.
There is a widely held perception that people without insurance flock to ERs because federal law requires that all patients be treated and stabilized regardless of ability to pay.
And in 2006, the rate of ER use among uninsured patients was 452 visits per 1,000 people, 1.2 times greater than the 367 per 1,000. The uninsured were almost a third more likely to be treated and released with no additional care from the hospital than were patients with private insurance coverage.
But researchers have also found that after taking into account health status, income and the local availability of primary care, the uninsured don't use the ER much differently than people with private insurance.
The National Center for Vital Statistics reports that for adult visits in 2006, the biggest share of ER patients, 40 percent, were covered by private insurance, while 17 percent were uninsured, and the rest covered by government insurance programs.
But an analysis by the federal Agency for Healthcare Research and Quality found a little different picture based on reports from about 1,000 hospitals that also included children.
It showed that 40 percent of all ER visits were covered by public insurance -- Medicaid and Medicare -- and just 34 percent billed to private insurance. Worker's compensation paid for 6 percent, and the uninsured were responsible for 18 percent.
Yet, as the Johnson Foundation study notes, the growing use of emergency departments for ambulatory care "signals deterioration in access to primary care regardless of patients' insurance status."
(E-mail Lee Bowman at BowmanL(at)shns.com)
(Distributed by Scripps Howard News Service, http://www.scrippsnews.com)
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