Before September ends, I need to turn my attention to some of the excellent studies in this month’s issue of Health Affairs. The focus here is on where Americans go for health care–especially as it concerns going to the emergency room. You’ll have to excuse the increasingly brief nature of my posts, they won’t always be so short, but I’m really trying to graduate in a timely fashion. Okay, I feel better now that that’s out there. On to the studies.
For starters, Stephen Pitt and colleagues find that fewer than half (42%) of patients’ acute care visits are to their primary care physician, while 28% are made to emergency rooms. The issue? Non-emergent care delivered in ERs is inefficient, and the last thing we need to be doing in this country is wasting more money on health care. So how do we get people to stay out of the ER when they don’t have an emergency? Well, for Medicaid patients, increasing co-payments for nonemergency use of ERs doesn’t work. Perhaps it would help if we made other alternatives more widely available? Apparently the answer here is yes and no. In rural counties with a community health center, ER visit rates were 33% lower than they were in counties without a community health center. At the same time, however, other research finds that people are still going to the ER when they could just as well be going to more efficient urgent care centers or retail clinics (the so-called “Doc in a Box”). This, I fear, is a sociological phenomenon, and effectively targeting policy to change it is likely to remain a challenge for quite some time.