Nearly half of all U.S. medical care is delivered by emergency departments (EDs), according to a study by researchers at the University of Maryland School of Medicine (UMSOM). And in recent years, the percentage of care delivered by EDs has grown. The paper highlights the major role played by emergency care in U.S. health care.
“I was stunned by the results. This really helps us better understand health care in this country. This research underscores the fact that emergency departments are critical to our nation’s health care delivery system,” said David Marcozzi, an associate professor in the UMSOM Department of Emergency Medicine and co-director of the UMSOM Program in Health Disparities and Population Health. “Patients seek care in emergency departments for many reasons. The data might suggest that emergency care provides the type of care that individuals actually want or need, 24 hours a day.”
Although he now focuses on population health, Dr. Marcozzi is an ED doctor himself who works one or two days a week in the University of Maryland Medical Center ED, treating patients.
This is the first study to quantify the contribution of ED care to overall U.S. health care. The paper appears in the latest issue of the International Journal for Health Services.
For this study, Dr. Marcozzi and his colleagues examined publicly available data from several national health care databases, which covered all 50 states and the District of Columbia. They studied the period between 1996 and 2010.
For 2010, the most recent year studied, the study found that there were nearly 130 million ED 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 ED visits, which are generally at least somewhat unexpected.
Over the 14-year period of the study, more than 3.5 billion health care contacts—ED visits, outpatient visits, and hospital admissions—took place. Over that time, emergency care visits increased by nearly 44%. Outpatient visits accounted for nearly 38% of contacts. Inpatient care accounted for almost 15% of visits.
Certain groups were significantly more likely to use the ED as their method of health care. African-American patients were significantly more likely to have ED 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 ED visits than any other group. And patients living in the South were significantly more likely to have ED visits than patients living in other areas of the country.
African-American patients used EDs at a higher rate than other groups. In 2010, this group used the ED almost 54% of the time. The rate was even higher for urban African-American patients, who used emergency care 59% of the time that year. ED use rates in the south and west were 54% and 56%, respectively. In the northeast, use was much lower, at 39% of all visits.
Certain groups accounted for increasing percentages of overall ED use: African-Americans, Medicare and Medicaid beneficiaries, residents of the south and west, and women. Dr. Marcozzi says that these findings point to increasing use by vulnerable populations, which is no surprise since socioeconomic and racial inequality creates barriers to the use of health care.
The use of emergency care resources for nonemergency cases has been controversial, since initial emergency care patients often end up being seen for nonemergency medical issues. Some experts argue that EDs are covering for deficiencies in inpatient and outpatient resources, and for a lack of effective prevention strategies. This could contribute to the high rate of ED use. They argue that ED use should be reduced.
Dr. Marcozzi says this is unlikely to happen anytime soon, given the structure of the country’s health care system. He also notes that it may not be the best option. Instead, he says we should work to connect the care delivered in EDs with care delivered by the rest of the health care system.
Source: EurekAlert; October 17, 2017.