Overuse of Emergency Departments Among Insured Californians

This report examines the factors leading to inappropriate emergency department use by insured patients in California and recommends strategies to increase alternatives to ED use.

October 2006

One of the key challenges facing emergency departments (EDs) nationwide is a marked increase in use, driven primarily by insured patients who do not have true emergencies. With the troubling trend in California of emergency room closures, it is important to examine the factors that lead to inappropriate emergency room use.

A 2006 Harris Interactive Inc. survey found that nearly half of recent ED patients felt their problems could have been handled by a physician’s office visit, had one been available, rather than using the ED.

CHCF commissioned Harris Interactive to conduct two sets of surveys, one of emergency room patients and one of primary care physicians and ED physicians. The patient survey found four key factors that drive increased ED use by insured patients who are not critically ill:

  • Lack of access to medical care outside the ED (such as same-day appointments with a primary care physician, or evening and weekend appointments);
  • Lack of advice on how to handle sudden medical problems;
  • Lack of alternatives to the ED (such as nurse advice lines or urgent care clinics); and
  • Positive attitudes about the ED as a site of care.

The lack of options for Medi-Cal patients, who have even more trouble with access to primary care than privately insured patients, is especially severe. The study also noted that patients with chronic conditions made more ED visits, suggesting that their primary care providers may need to improve their methods of chronic disease management.

This issue brief summarizes the key findings of the survey, recommends strategies to increase alternatives to ED use, and calls for streamlined ED processes, as well as improved communication between physicians and patients.

The issue brief and the complete survey findings are available under Document Downloads.