Why do people with insurance overuse the Emergency Department?

Why do people with insurance overuse the Emergency Department?

When I posted recently that it looks like the uninsured aren’t to blame for ED overcrowding, Flea asked in the comments section why people with insurance overuse the ED. (FYI, Flea is really into this topic and even has a post about it today.) I don’t think anyone can really answer that question in a quantitative way, but here are some thought starters with real examples.

  1. Patient goes to their doctor for something seemingly minor, then is told to go to the ED. Example: a mother takes her seven year old son to the doc for a cut, expecting the pediatrician can stitch it up, but is sent to the ED. Next time she’ll head straight for the ED.
  2. Patient lacks a good relationship with PCP despite having insurance and doesn’t feel comfortable making contact for the first time on an emergent issue. Example: healthy woman who’s recently finished having kids has a PCP selected for HMO registration purposes but hasn’t seen the doc in years and the issue isn’t appropriate for her OB/Gyn. Off to the ED she goes.
  3. Problem occurs outside of business hours; patient’s own doc is not on call or hard to reach. Real or perceived barriers to communication are high. Example: A house guest dies of meningitis two days after departure. Parents are worried about whether their kids need to start therapy. Time is of the essence and the on-call pediatrician doesn’t call back right away. Hello, ED.
  4. A minor issue escalates over time into something major and by then the ED is the only realistic solution. Example: Older man with mild/moderate chronic conditions has flu-like symptoms during the week but doesn’t want to bother his doctor. Condition worsens over the weekend, wife gets nervous and makes him go to the ED.

I could go on, but those are some of the reasons I see. In another post I’ll talk about some possible solutions.

July 25, 2006

4 thoughts on “Why do people with insurance overuse the Emergency Department?”

  1. Add in drug seeking. The PCP won’t give narcs, benzos or inappropriate antibiotics, so off to the ED the patient goes. We see this a lot.

  2. If you’ve got insurance, going to the Emergency Room is generally a *known* cost. Maybe it’s $100, when your copay for the doctor is $15 or $20, but the ER can see you after hours, without appointment, etc. Most of us can manage $100 if we think it’s fairly important, and we’re worried.

    If you don’t have insurance, though, then the cost of going to the Emergency Room is completely unknown. From experience, and anecdotes from others, people know/believe that if they go to the emergency room for something, they will quite likely come out with a bill for $600, $900, $1500, or more, complete with $25 aspirins and $40 gauze bandages. In that case, it’s often better to just suck it up and live with it, rather than pay for that visit for the next year.

    BTW, this is one of the reasons why these for-profit quick clinics are going to be a huge success, assuming medical lobbyists don’t stop them with legislation. Known cost, quick service = success.

  3. I have yet to call the on call doctor about anything, including spiking a 105 degree fever while on chemo, and not had them tell me to go to the emergency room. Why bother waking the doctor up?

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