Emergency department visits increase, but not solely by uninsured

More than one in five people in Colorado regularly use the emergency room as part of their medical care, but it’s not always the uninsured who turn up for treatment, according to a new report from the 2011 Colorado Health Access Survey, a survey administered by The Colorado Trust.

Most people aren’t in the emergency room because they have actual emergencies, the report found, which points to challenges in improving access to care and lowering costs.

Colorado’s patients are paralleling national trends – use of emergency departments is increasing. During, 2011, nearly 1.2 million people in the state visited the emergency room at least once a year, up from 1 million in 2008-2009. Coloradans without health insurance had one of the lowest rates of usage, 21 percent, slightly above that of people paying with private health insurance.

People insured by Medicare and Medicaid had much higher emergency room use rates, maybe because the population covered by the programs mirrors the population using the emergency room most often: young children, older adults and people with disabilities or in poor health. But people also report that it’s difficult to find a doctor who will accept Medicaid insurance.

The CHAS found the rate in Colorado to be much higher than national estimates. More than four in 10 Coloradans who visited an emergency room n the past year reported that their last visit was for a condition that could have been treated in a doctor’s office or clinic. Nationally, one-quarter of all acute-care outpatient visits in the nation now take place in emergency departments, according to a 2010 study published in Health Affairs.

Asked why they went to the emergency department for a non-emergency, Coloradans reported these reasons:

• 79 percent said they needed care after physician office hours;

• 63 percent reported they weren’t able to get an appointment as soon as they needed it;

• 45 percent said the ED was more convenient.

The high emergency department use by Medicaid patients has state leaders worried, particularly since higher enrollments are expected from the federal health care reform law.

“Emergency Department use is a complex issue. The CHAS findings give us information and raise some necessary questions. We have to examine and address the availability and affordability of acute care for both insured and uninsured Coloradans,” said Ned Calonge, MD, president and CEO of The Colorado Trust. “EDs are an important part of our health care system and we must give careful consideration to how they should be used if we want to improve health care and lower costs.”

Other findings about emergency room use from the 2011 CHAS include:

• Underinsured Coloradans – those with health insurance but who still spend more than 10 percent of their income on medical expenses – used the ED at a rate of 30 percent, more often than uninsured individuals (21 percent) or Coloradans with private insurance (19 percent).

• The highest rates of ED use were reported for young children and adults age 65 years or older, people with disabilities or in poor health, non-Hispanic blacks and individuals with the lowest incomes.

• ED visits were lowest (12 percent) in the mountain resort counties of Eagle, Garfield, Grand, Pitkin and Summit, and highest in Mesa County (32 percent). These differences likely are linked to patterns of income, insurance coverage and demographic characteristics.