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Does Health Coverage for More Californians Make Emergency Rooms Less Crowded and Save Money?

Maribeth Shannon

Emergency room use in California has been riding the "up" escalator for years. It climbed from 261 visits per 1,000 Californians in 2003 to 312 visits per 1,000 in 2012 (source: California Hospitals, 2015). Many people believe that expanding insurance coverage would enable more people to see primary care doctors, and thus reduce emergency department traffic.

 

Myth or Fact?
Myth or Fact?

Here are the facts.

FACT: The uninsured are less likely than insured people to use the emergency department.

Among California's uninsured, only 14% have visited an emergency room in the past year. That compares to an average of 19% for the total population. This is true despite the fact that low-income folks generally use the emergency room more frequently (23% of those who live at the federal poverty level have done so in the past 12 months). Among Medi-Cal enrollees, 27% have used the emergency room. As more people gain coverage, particularly through Medi-Cal, emergency room use is likely to go up, not down. (Source: AskCHIS, 2011-2012.)

FACT: Most emergency room visits are for conditions considered moderate or severe, and the ED is an appropriate place for care.

Though some emergency department patients could be treated by a primary care physician, only about one in four emergency visits are for minor conditions (source: California Hospitals, 2015). This is confirmed by responses from low-income Californians to a recent survey sponsored by the California Health Care Foundation (CHCF). A large majority (62%) said they went to the ED because they thought it was an authentic medical emergency.

FACT: It isn't just about having coverage — it's how the coverage is designed.

A recent study in Health Affairs found that when coverage programs for low-income people had promoted the use of primary care doctors, the result was fewer emergency room visits and hospitalizations. (Source: N. Pourat et al. in Health Affairs, July 2015.)

About Maribeth

Maribeth Shannon ended her 12 years of service to CHCF as director of Informing Decisionmakers, helping to develop reliable information to assist decisionmaking for a broad range of audiences, including policymakers, providers, and purchasers of health care services.

Prior to joining CHCF, she served as assistant vice president for clinical services development for the University of California. She has also been executive director for an alliance of hospitals and medical groups in the San Francisco area, benefits manager for a major retail company, and in various management positions at Blue Cross of California.

Maribeth received a bachelor's degree in communications and industrial engineering from Northwestern University and a master's degree in health administration from the University of Colorado.

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