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Poor health, not lack of insurance, drives ED visits

Uninsured patients accounted for only 15% of emergency department visits.

By Damon Adams, amednews staff. Nov. 22/29, 2004.

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Researchers say a new study debunks the myth that the poor and uninsured are overcrowding emergency departments across the country.

The study published online Oct. 19 by the Annals of Emergency Medicine found that 85% of emergency patients had health insurance and 83% of ED visits were made by people who had a usual source of care such as a primary care physician. People without insurance were no more likely to visit the emergency department than people with insurance.

The mistaken belief that departments are overfilled with the uninsured can lead to misguided policy decisions, said Ellen J. Weber, MD, lead study author and professor of clinical medicine in the division of emergency medicine at the University of California, San Francisco. The stereotype of uninsured patients cramming EDs has been spread by studies that have involved smaller samples of patients and focused on ambulatory and nonurgent patients, she said.

"Most studies were not done nationwide when they looked at emergency department [crowding]," Dr. Weber said.

The study stated, based on a sample of 49,603 adults interviewed between 2000 and 2001, that an estimated 45.3 million adults reported at least one ED visit, resulting in 79.6 million visits. From 1992 to 2002, emergency department visits grew 23% from 89.8 million to 110 million.

The majority of patients going to the ED said they usually got care through a private physician's office. Only 5% said the ED was their usual source of care. Patients without insurance accounted for 15% of ED visits. Poor physical health and poor mental health were the main driving forces for ED visits, according to the study, which will be published in the Jan. 2005 Annals print edition.