August 11th, 2010
05:44 PM ET

Hospital emergency department visits still rising

More people are receiving treatment at emergency departments in U.S. hospitals.

A study by the University of California at San Francisco finds that from 1997 to 2007 emergency department visits rose from 94.9 million to 116.8 million.  "This is a 23 percent increase, which is twice the growth of the general population," lead study author Dr. Ning Tang said.

The study, published in the Journal of the American Medical Association,  also finds that the number of emergency departments treating a disproportionately high number of Medicaid and uninsured patients increased by 46 percent from 2000 to 2007.  These departments, classified as "safety net EDs" by the Centers for Disease Control , now represent almost two-thirds of all EDs in the U.S. according to the study.

The number of adults on Medicaid accounted for a large part of this growth. The researchers also found that compared with adults with private insurance, adults with Medicaid were the only ones to increase their visits to EDs for conditions that could have been treated at primary care clinics.

"We're concerned that it could be due to poor access to primary care or it can be due to poor quality of primary care, meaning they get in to be seen but they're not being well-managed by their primary care physician so they end up going to the ED," Tang said.

The researchers found that the median wait times to see a doctor in an emergency department went from 22 minutes to 33 minutes and the number of EDs in the U.S. decreased by 5 percent to 3,925 by 2007.

"The number of visits are going up; we've known that for the last few decades, and yet EDs are continuing to close. EDs are being overburdened and more  and  more people are going to fewer EDs to get their care," Tang said. "We're expecting more people to enroll in Medicaid both as a part of the recession and also as a part of the health care reform bill. We really need to make sure that these patients have access to a primary care physician. Otherwise, if we don't, it will likely add additional strain to our already overwhelmed EDs.

soundoff (16 Responses)
  1. Terri

    I can tell you that my own personal visits to ERs have increased over the last two years. I am a chronic migraine sufferer, and doctors are so afraid to prescribe pain medications that do ease my migraines (and sometimes completely get rid of them), that in order for me to get proper treatment I need to visit the ER for relief. I am allergic to the "triptan" drugs that are primarily used for migraines, so I usually need to have narcotics to relieve the pain. I let it go as long as I can before going in, but when it's been 5 days with no decrease in symptoms and increase in pain, that's more than enough for me and I have to go.

    August 11, 2010 at 18:44 | Report abuse | Reply
    • Patton

      Terri, there are pain management centers who can provide this service with "emergency" pain medicines that can be maintained available for you when you have migraines. This is far more cost-effective and frankly, easier for you, better for the system as a whole. Ask your PCP or neurologist for a referral.

      August 11, 2010 at 22:43 | Report abuse |
    • Virginia

      Pain Clinic's are not good. They are overpaid physicians shelling out pain pills unnecessarily to people who then become dependent on them and begin to take more than prescribed. If you have a problem with your migranes, you should go and see a specialists who can treat you with medication other than what your allergic to. Pain clinics should be shut down for causing America's Rx drug problem.

      August 12, 2010 at 15:41 | Report abuse |
  2. Patton

    As an orthopedic surgeon, I see patients daily that have visited the ER for a variety of musculoskeletal problems, many of which are justified. However, I also see a substantially growing population of people with either no insurance or Medicaid that, despite what they may think, go to the ER with injuries or painful conditions that are NOT emergencies. After 10 years of practicing, I try to educate these people that our offices are almost always available the following day for walk-ins. Unfortunately, many of these people lack the maturity or educational level to make rational decisions. And frankly many of their injuries are often attributable to these same reasons. Yes, there is some problem with access to those with Medicaid, but this is NOT the primary reason that people go to the ER. They go because they know they can be seen at any time, for any reason, without any cost to them. There simply is no accountability. Oh, unless you count the $2 co-pay they must forfeit at each visit-that is, if they have it–otherwise they still have to be seen. Examples include the three week old ankle sprain that suddenly decides to go to the ER because he is not healed; numerous hand fractures to young men who cannot control their anger enough to avoid punching a wall; the woman who goes from one ER to another ER across town in order to be seen for back pain because the first ER physician wouldn't prescribe her choice of pain medicine; etc. etc. etc. I've seen it all. The system is destroying itself and cannot be sustained. We need more accountability from everyone, patients included; and need to be able to triage and ultimately turn away some patients with clearly non-emergency conditions, directing them to on-call physician offices the following day for more appropriate, cost-effective care.

    August 11, 2010 at 22:37 | Report abuse | Reply
    • Dems

      As an ED Physician, I totally agree. Nothing can stop a patient from going to 4 different ED's in one day seeking the 'proper' prescription. Why can't medicaid or medicare monitor these and educate patients. You do not see people with private insurance do this. With rehards to people with no insurance, sky is the limit. They do not have the legal obligation to pay and be more responsible. I have seen patients return to ED after several hours, hoping the next MD will prescribe the things they want. Very frustrating and clogs the ED unnecessarily.

      August 11, 2010 at 23:47 | Report abuse |
  3. Anne

    I will soon become one of the millions of uninjured in this country-whY? Want irony? I'm employed by a large Health Care provider in CA. I've been an employee for 14yrs-now I've been forced to take a position that offers no medical benefits- and not enough hours to afford medical insurance. I will now be forced to go to the ED when a once minor problem turns into a major medical issue. Having had to go to an ED for emergency care-will wait until it cannot be managed at home any longer. I am neither uneducated, nor do I "lack maturity" I just lack medical insurance at this point

    August 12, 2010 at 04:43 | Report abuse | Reply
    • Melone

      I think what the E.R. docs are suggesting is you go to Urgent Care or your general doctor with a credit card rather that the E.R. so that the E.R. traffic will be manageable.

      I am so sorry you are losing your insurance. Your employer should be ashamed.

      August 12, 2010 at 08:22 | Report abuse |
  4. Melone

    How is a multiple hand fracture not an "emergency?" Are you stating that it isn't one so you don't have to provide ED care?

    I think for true non-emergencies, perhaps the laws need to be changed to start requiring a credit card payment prior to treatment, but broken bones are an emergency, since they can lead to infection and permanent difficulties.

    For those shopping for pain meds, can't the E.R. say "We aren't able to provide pain management through the E.R. See your general practitioner tomorrow?" Why are they allowed past triage?

    p.s. I am pretty sure "visiting the E.R." was Bush's plan for providing everyone with health care. Sorry, I couldn't resist pointing that out.

    August 12, 2010 at 08:20 | Report abuse | Reply
  5. Warria


    There is a safety net system of health care called Federally Qualified Health Centers – ready, willing and able to meet the primary care needs of all patients, regardless of ability to pay. One of their many missions is to provide access to care, hopefully preventing unnecessary ER visits. If you go to bphc.hrsa.gov you can locate one in your area.

    Please know they are not a "clinic". Most assign you a PCP who will be you main care provider.

    Good luck!

    August 12, 2010 at 08:26 | Report abuse | Reply
  6. Kim

    Personally I believe that all primary MD's should open with at least two late nights per week and every other weekend. The weekend that they are not available, they should be able to transfer the care of their patient across to a covering doctor. I also believe that there should be 24 hour STD/pregnancy clinics. This might take the drain off the ER.
    Also I believe that the government should advertise more freely on when to attend a hospital and when it is not apporopriate to. Sometimes people attend the ER for the slightest reasons, not knowing where the nearest urgicare center is. Eg concentra, healthworks, walgreens, etc. If the advertising was more upfront, this may allow the ER to take care of the critically ill and those who are chronically ill.

    I believe that the general public are credible enough to know when they are unwell. They just need the correct place to attend and to have their symptoms treated. They are also able to make responsible decisions.
    Moreover people should be fined if they call the ambulances for irrevelant nonsense, e.g. toothache, nausea and vomiting after excessive alcohol use / that ambulance is being taken away from a small pool of vehicles to cover an entire city.

    Nobody likes an ER. But if you have no health care and you have not had access to primary health care, there is a certain sense of entitlement that some people possess towards being able to have care, where and whenever they need it. This is wrong. I would also like to add that many of the medical centers that we expect people to go to don't give out appointments for a couple of months. In a country where there is no kudos given to delayed gratification, people expect to get treated quickly and efficiently. And if the treatment is not according to their requirements, then the healthcare professional is at risk of a lawsuit. It appears to be a lose/lose situation.

    When the healthcare reform was made, it should have included Tort reform to protect those in Emergency medicine who consistently serve our often thankless community.

    August 12, 2010 at 09:05 | Report abuse | Reply
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