Emergency department utilization 2000 – 2010

Objective

Analyze the utilization of emergency departments (EDs), focusing on National Hospital Ambulatory Medical Care Survey (NHAMCS) classified non-urgent visits based on insurance status, region, gender, age, and race/ethnicity.

Method

NHAMCS ED summarized data for years 2000-2010 and compiled into a statistical spreadsheet.  Descriptive statistics was used to analyze utilization.

Population Studied

Privately insured, Medicaid, Medicare, and uninsured.

Results

Since 2000, ED visits increased from 108,017,000 to 129,843,000 visits in 2010 peaking at 136,072,000 in 2009 with a mean of 116,089,000 during the eleven-year period. The biggest increase occurred between 2007 and 2009.  Most ED visits occurred in the South region of US.  In 2010, the South had the highest rate of uninsured of the regional cases at 20.5 percent.  Since 2000, the majority of ED visits have been classified as urgent.  The overall mean for non-urgent visits was 11,825,455.  In total, there were 130,080,000 known non-urgent ED visits during 2000 – 2010. Since 2007, the rate for non-urgent classification has remained relatively stable at an average of 7.65 percent.  The non-urgent classification rate was the lowest during 2010 at 7.0 percent.  From 2002 – 2008, those in the private insurance group led the number of non-urgent ED visits.  However, in 2009 and 2010, the Medicaid group had the most number of non-urgent visits of all insurance status groups.  Every year starting from 2002, the Medicaid group led the uninsured group in non-urgent visits.  Ages 25 – 44 had the most ED visits during 2000 – 2010 with a mean of 33,944,091 visits, mostly due to injuries.  The same age group also led non-urgent ED visits.  Ages 65 and over had the lowest ED utilization.  Females visited in increased numbers for non-urgent purposes.  The number of whites visited more often than any other race.  Whites had the highest number of non-urgent visits.

Conclusion

When comparing uninsured and Medicaid patients from 2001 -2010, the Medicaid group had incurred more ED visits, even for non-urgent purposes.  In times of perceived medical emergencies, historical results have shown that regardless of insurance status, ED visits continue to rise; however, non-urgent visits have remained relatively stable since 2007.

 

Implications

Medicaid expansion will increase ED utilization due to regional primary care shortages.  Policies need to be created or modified to reduce non-urgent visits, for example, incentives for primary care physicians, a modification of the Emergency Medical Treatment and Active Labor Act, increased ED co-pays, and health literacy.