Emergency Room Use Persists Despite Gains in Insurance Coverage

Lilo H. Stainton | February 24, 2017 | Health Care
Healthcare habits are proving slow — and somewhat difficult — to change

Urgent care
While most New Jersey residents get the majority of their medical care from their doctors, emergency rooms continue to be the first choice for some patients, regardless of their medical problems.

Data released Wednesday by the New Jersey Health Care Quality Institute and the Eagleton Center for Public Interest Polling showed that more than half those questioned seek care exclusively from their physician and another third do so “some of the time.”

But the emergency room was the second most popular source of care and 8 percent of patients go there exclusively, the poll found. Some 56 percent use the ER occasionally.

Experts agree emergency departments are not optimal for primary and preventive care, addressing chronic illnesses, or other nonemergency needs; routine treatments can be far more costly than when provided by a private physician, and patients may be forced to wait while emergency doctors treat priority cases.

The federal Affordable Care Act was designed in part to expand insurance coverage in hopes that more patients would be able to receive appropriate care, at lower costs, from primary care doctors. But while the ACA added 800,000 Garden State residents to the insurance rolls — dropping the state’s uninsured rate to 8.7 percent, the lowest in three decades — the findings indicate some patterns of healthcare use are slow to change.

“Shifting care from emergency rooms to physician offices or community health centers that have same-day scheduling or extended hours, or using urgent care facilities in appropriate circumstances, would reduce costs for people, employers, and government-funded programs, such as Medicaid and Medicare,” said Linda Schwimmer, president and CEO of the New Jersey Health Care Quality Institute. The poll also explored the use of urgent-care clinics and found respondents were willing to try these walk-in services, but few had done so.

According to the National Centers for Disease Control and Prevention, while roughly 20 percent of Americans seek ER care at some point in a year — a rate that has remained stable for years — nearly half of these patients don’t consider a doctor’s office an option, going straight to the hospital emergency department instead. The rate is much higher, nearly 35 percent, for Medicaid patients.

The persistent use of emergency care is a big concern for hospitals, which must provide treatment regardless of a patient’s ability to pay. The state Charity Care fund, used to reimburse hospitals for the medical services they provide to those without insurance, has been cut by hundreds of millions of dollars in recent years, including a $150 million reduction this fiscal year.

State officials note that data submitted by hospitals, used to calculate Charity Care payments, has dropped significantly in recent years, and Gov. Chris Christie credited the insurance expansion prompted by the ACA in his budget address last year. But hospital officials insist that, even with more insured patients, they are losing money on many of these procedures.

The Eagleton/HCQI poll also found nearly two-thirds of women, but only 48 percent of men, chose a doctor’s office “all the time,” while the rest opt for ERs, community clinics, walk-in providers, or urgent care. White residents were also more likely to visit a physician than nonwhite residents; in fact, 18 percent of residents of color said they never went to a private doctor — three times the rate of whites. Those with higher incomes and more education also showed stronger preference for the physician, while those earning less were more likely to go to the emergency room or a community healthcare facility.

“Key differences in care settings emerge by gender, race, age, and income — some of which are likely due to personal preference and others, because of systemic barriers,” said Ashley Koning, director of the Eagleton Center for Public Interest Polling. Studies have shown that lower-income communities often have fewer healthcare options, especially for primary care.

Only 5 percent of those polled said they always visit a community health center; 4 percent selected a walk-in clinic or retail provider; and 3 percent always chose an urgent-care facility. Opposition to community clinics and walk-in providers was the greatest; nearly eight in 10 respondents said they had never received treatment at those types of facilities.

But they remain far more open to urgent-care clinics. Some 46 percent said they had used urgent care occasionally — but not exclusively — and roughly two-thirds said they were at least somewhat comfortable with the idea.

The poll involved 772 adults living throughout the state who were contacted between October 28 and November 3. Interviews were done in English or Spanish, when requested.