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Nearly half of medical care comes from emergency rooms, study shows

Researchers find increasing use by vulnerable populations as socioeconomic and racial inequality creates barriers to the use of healthcare.

Jeff Lagasse, Associate Editor

Nearly half of all medical care in the U.S. is delivered by emergency departments, according to a new study by researchers at the University of Maryland School of Medicine. And in recent years, the percentage of care delivered by emergency departments has grown.

For the study, the authors examined publicly available data from several national healthcare databases, which covered all 50 states and the District of Columbia. They studied the period between 1996 and 2010.

[Also: Mississippi hospital latest to charge upfront fees at emergency room]

In 2010, the study found there were nearly 130 million emergency department visits, compared with almost 101 million outpatient visits and nearly 39 million inpatient visits. Inpatient visits typically involve a hospital stay, but are planned ahead, as opposed to emergency department visits, which are generally at least somewhat unexpected.

Over the 14-year period of the study, more than 3.5 billion healthcare contacts -- emergency department visits, outpatient visits and hospital admissions -- took place. During that time, emergency care visits increased by nearly 44 percent. Outpatient visits accounted for nearly 38 percent of contacts, while inpatient care accounted for almost 15 percent of visits.

[Also: Freestanding emergency departments target high-income areas, report says]

Certain groups were significantly more likely to use the emergency department as their method of healthcare. Black patients were much more likely to have emergency department visits than patients in other racial groups; patients in the "other" insurance category, which includes those without any type of insurance, were significantly more likely to have emergency department visits than any other group. And patients living in the South were much more likely to have emergency department visits than patients living in other areas of the country.

Black patients used emergency departments at a higher rate than other groups. In 2010, this group used the emergency department almost 54 percent of the time. The rate was even higher for urban African-American patients, who used emergency care 59 percent of the time that year. Emergency department use rates in the south and west were 54 percent and 56 percent, respectively. In the Northeast, use was much lower: 39 percent of all visits.

Certain groups accounted for increasing percentages of overall emergency room use: blacks, Medicare and Medicaid beneficiaries, residents of the south and west, and women. The authors said these findings point to increasing use by vulnerable populations -- no surprise, since socioeconomic and racial inequality creates barriers to the use of healthcare.

The use of emergency care resources for non-emergency cases has been controversial, since initial emergency care patients often end up being seen for non-emergency medical issues. Some experts argue that emergency departments are covering for deficiencies in inpatient and outpatient resources, and for a lack of effective prevention strategies, the report said. This could contribute to the high rate of emergency department use. These experts contend that emergency room use should be reduced.

The authors said this is unlikely to happen anytime soon, given the structure of the country's healthcare system. They also said it may not be the best option. Instead, a better approach may be to work to connect the care delivered in emergency departments with care delivered by the rest of the healthcare system.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com

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