From 1997 to 2007, the rates of visits to emergency departments in the United States increased significantly, particularly among adults with Medicaid, according to a recent study.
Ning Tang, MD, of the University of California, San Francisco and colleagues examined changes in emergency department (ED) visit rates in the United States to evaluate the hypothesis that EDs are serving in a safety-net role for an increasing segment of the U.S. population. Data from the National Hospital Ambulatory Medical Care Survey from 1997 through 2007 were stratified by age, sex, race, ethnicity, insurance status, safety-net hospital classification, triage category and disposition. Emergency departments were classified as safety-net facilities if they provide more than 30% of total ED visits to persons with Medicaid, more than 30% of total ED visits to uninsured individuals, or a combined Medicaid and uninsured patient population greater than 40%. Visit rates were calculated using annual U.S. census estimates, according to a press release.
The researchers found that between 1997 and 2007, total annual visits to U.S. EDs increased from an estimated 94.9 million to an estimated 116.8 million, an increase of 23.1%, with this increase being almost double what would be expected from population growth during this period. Emergency department visit rates increased from 352.8 to 390.5 per 1,000 persons between 1997 and 2007. Although the number of ED visits increased, the number of EDs available to the U.S. population decreased by 5% during this period. Factoring in the growth in the U.S. population, visits by the 18- to 44-year-old and 45- to 64-year-old populations accounted for the greatest increase in ED visits.
ED visit rates among adults with Medicaid increased significantly between 1999 and 2007, from 693.9 to 947.2 visits per 1,000 enrollees. Adults with private insurance and Medicare, as well as the uninsured, showed no significant change in ED visit rates. Among adults with Medicaid, the ED visit rate for ambulatory care-sensitive conditions per 1,000 enrollees increased from 66.4 in 1999 to 83.9 in 2007.
The researchers also found that from 1997 to 2007, median ED wait times to see a physician increased from 22 minutes to 33 minutes. Also, the number of facilities qualifying as safety-net EDs increased from 1,770 in 2000 to 2,489 in 2007.
“Our findings suggest that increased enrollments in Medicaid between 1999 and 2007 have had substantial effects on ED volume and crowding and that at least part of this may reflect limited access to primary care services for Medicaid enrollees,” Tang stated in the release. “A deeper examination of the differential access to primary care by insurance type is needed to better understand health care utilization patterns by patients with Medicaid, and to develop more effective strategies for reducing pressure on the safety net.”