Emergency Room Myths

The overutilization of emergency rooms is often cited as a dangerous symptom of America’s broken healthcare system. But a new Slate article from Zachary Meisel and Jesse Pines offers a rosier picture of emergency room usage, and dispels several pervasive myths. They write that E.R. care represents less than 3 percent of healthcare spending, only 12 percent of E.R. visits are non-urgent, and the majority of E.R. patients are insured U.S. citizens, not uninsured, illegal immigrants. Meisel and Pines also point out that E.R. visits don’t necessarily cost more than primary care visits: “In fact, the marginal cost of treating less acute patients in the ER is lower than paying off-hours primary care doctors, as ERs are already open 24/7 to handle life-threatening emergencies.” Ultimately, Meisel and Pines believe that emergency rooms are functioning as they’re supposed to, as “an always-available resource to alleviate pain, make sure your baby is not truly ill, and patch you up after a nasty fall is vital, even if it turns out that your condition wasn’t as serious as you feared.”[%comments]


Gordon

Next you'll tell me that most people on welfare aren't irresponsibly having more kids to get more benefits!

Brett

The other related myth is that people in the U.S. are being denied health care. The ERs doing what they're supposed to is proof that people do in fact have available health care.

Health insurance is not as easy to come by however, and preventative care is also not as common as it should be. But health care itself is available with no questions asked - and it's affordable in the sense that if you can prove an inability to pay, the costs are usually waived.

Bill

On other points we found the president's facts checked out. For example, many countries that spend much less on health care nevertheless have higher life expectancy than the U.S. And while we find it doubtful that the uninsured cost other families $1,000 in higher premiums alone, once higher taxes and higher medical costs are factored in, the price tag for the uninsured could well be that high.

factcheck.org

Shmoe

Yea, because The benefits of another kid vs. more money from welfare really work out on paper. You probably also believe people would rather collect unemployment than work and make loads more money too. Right, Gordon?

Bill Mill

Their source for that 12 percent number is a frikkin' press release: http://www.acep.org/pressroom.aspx?id=45122. My wife's an ER physician, I'll ask her, but based on listening to her that number seems way low and I'd want to know its source. (I'm a biased observer of a biased observer, I know)

Ann

The marginal cost of treating nonurgent patients in the ER might not be that high to the hospital, but it definitely is higher to the patient, insured or not.

Another scenario that this doesn't account for however, is the patient who comes into the ER with a life threatening (and therefore more costly) illness that could have been treated much more cheaply before it became life threatening. This happened to a friend of mine recently. She had an illness that could probably have been treated with an office visit and a round of antibiotics. Because she didn't have insurance, she didn't go to the doctor. Instead, she spent 10 days in ICU, and the bill will probably be in 6 figures. Since she still doesn't have insurance, and likely won't be able to work for some time, someone else (the state, the hospital) will end up picking up the bill.

Gordon

Shmoe, do they have sarcasm where you're from?

hal

I think it's a self-selection stat (no pun intended). Those deemed non-urgent by the clerk either leave or die of old age (non-emergent) waiting.

Brett

@Bill

Life expectancy is a terrible indicator of health care availability. Two major reasons:

1 - 'Life Expectancy' is a calculated figure and all countries use different calculations. So if the U.S. is calculating A+B=C, France may be calculating X+Y=C, at which point comparing 'C' is useless. (for example, many countries don't factor in premature/low birthweight babies which are less likely to survive - this artificially increases their life expectancy).

2 - 'Life Expectancy' is a calculation that is affected by more than just the quality of health care. Americans may (or may not) have a true lower life expectancy, but much of that is (or would be) caused by lifestyle choices. No matter what a doctor does to help me, if I'm munching nachos 24/7, I'm in big trouble (though enjoying the journey).

Marci Kiser

All due respect to the authors, but that's nonsense.

I work in a busy urban ER. Over half of the patient population that comes in and out is nonsense... joint pain for several weeks, stomachaches, mosquito bites, headaches, etc. And that's not even counting the rest home patients who are literally dropped off at the curb who have a low-grade fever or some minimum-wage twit has dislodged their feeding tube.

Anyone who thinks that an ER is cheaper than a PCP should answer me this: when is the last time an office doctor sent a patient for a full CT scan and cardiac workup because of some heartburn? When was the last time you x-rayed an elbow because of a pimple? How many fussy babies get sent from the pediatrician's office to have a full throat and rectal exam?

As I said, all due respect, but this report is rubbish.

Diz Pareunia

I haven't worked in ER's in years, but I do listen to the local paramedic calls on my scanner, and there is a huge proportion of trivial calls, I'm guessing because it is
a. free
b. much more convenient to have the care come to you than having to go several miles to it.

PT

The Slate article you cited has several comments that I think would be quite germane to the discussion. While this stem of an article focuses on the big picture, the problem is much more complex and decentralized.

Your experience referenced in the previous article about over-utilization of ERs, while perhaps exceptional, is still relevant to the discussion. There are some great details in this topic that should be quite a bit more compelling to an economist, such as:

1. Higher rates paid for ER service by the uninsured, due to likelihood of default.

2. The economic cost to hospitals located in communities with higher populations of indigent and uninsured residents, as opposed to those in generally wealthier areas. And then there's the question of whether those costs are passed on to other patients and if so, how the costs are ultimately distributed amongst the population -- whether the hospital takes on a higher share of public subsidies, charges the uninsured a higher rate, successfully nickel & dimes insurance companies, or blends the above options (or somehow gets more out of insurers and drives up the costs of the insured).

3. The regional economic impact of hospitals closing in marginal or poorer areas because they face the problems previously mentioned. In many cases, we rely on hospitals operated by large non-profit corporations, which sometimes must decide to withdraw management from one underperforming hospital for the benefit of the whole system. It's then up to the area served to decide whether they will create a tax base to keep the hospital operating or let the market sort it out.

Upon reading this article and those cited within, I was inspired to dig up a couple of stories that I recalled from Tucson, Arizona, where health care providers have created innovative ways to deal with these problems:

http://bit.ly/cIGfZv (very impressive and forthright example of dealing with the problem of under-insured patients over-utilizing facilities).

http://bit.ly/dguQkz (less innovative solution, but still helps to demonstrate the problem and show how the commons still matters in such an issue).

Read more...

Fizzy Blonde

The 12% statistic for non-urgent visits to the emergency department is from the CDC and you can find it on page 3 of the CDC's report here: http://www.cdc.gov/nchs/data/nhsr/nhsr007.pdf.

charles

Bill, 12% comes from the National Center for Health Statistics branch at the CDC. here is the link:

http://www.cdc.gov/nchs/data/ad/ad386.pdf

Marci you are wrong. I work at an ER too and it sure feels like we deliver a lot of non-urgent care. But we don't. Study after study has proven this. The majority of increased use of ERs come from primary doctors who are sending their patietns to the ER to get those CTs and cardiac tests.

This is the point of research... to test if commonly held beliefs are real or not.

Bill

@Brett

The life argument is simply part of the fact check. But the increased costs to the insured by the uninsured is real.

Neil (SM)

#10 (Marci Kiser)

And I suppose somehow you know that your experience applies to every ER in the country?

PW

This is nonsense. I work at a medical school; I got hives. I went to the emergency department. I waited four hours to see a doctor. That visit was billed out at $555.

Had I gone to my regular doctor (and I regret that I didn't), it would have been a relatively inexpensive office visit.

I have insurance, but the point is $555 is a far cry above $65, which is about what an office visit costs these days.

The subtext to all this is that it is less expensive for someone to go to a regular doctor in their office than to go to an emergency department to be treated. If it is truly an emergent situation, by all means go to the ED...but if you are talking about people who get sick who go to the ED as their mode of getting medical treatment, they would be better off to go to the doctor's office; they need to find a doctor who practices with several other doctors, so there is always a doctor, physician's assistant or nurse practitioner there. Always less expensive than a trip to the ED for something relatively minor.

Read more...

PT

#16 (Neil) brings up a great point. The total numbers, while relevant to today's hot-button HCR issue, are not as important as the statistics from different hospitals. Where's the regression analysis?

Darwin

I have a job and my parents had jobs. I have health insurance (but don't really need it). I take care of myself, and I will take care of my kids. Why should I care about natural selection doing it's job?

Andrew Bressler

American medicine is always blamed when lower life expectancy is mentioned but I wonder if the real differences are our drug use, gun violence (think of all the young adults killed in low income areas,) and vehicular accidents ( I suspect we drive many more miles per person than other countries where the mass transit is better and less interstate type highways). None of this has to do with health insurance or medical care. Factor those out to make fair comparison. And then there is the obesity issue...