Jama Logo In a recent study, we reported parents to prefer emergency rooms over pediatrician for even those kids who may require non-urgent care. But elevation in visits to emergency departments (EDs) seems to be found in adults too. A latest study suggests that from 1997 to 2007, the rate of visits to EDs in the U.S. heightened considerably among adults with Medicaid.

It was mentioned that EDs are health care providers in the United States. What is unique about them is that they give services to all irrespective of insurance or ability to pay. Scientists have lately noticed an elevation in the number of uninsured and underinsured people visiting emergency departments, with the potential effects of this a concern for the health care safety net. The study authors observed alterations in ED visit rates in the United States.

By conducting the analysis, scientists were probably able to ascertain the hypothesis EDs serve in a safety-net role for an increasing segment of the U.S. population. Ning Tang, M.D., of the University of California, San Francisco, and colleagues analyzed data from the National Hospital Ambulatory Medical Care Survey from 1997 through 2007. Information regarding age, sex, race, ethnicity, insurance status, safety-net hospital classification, triage category, and disposition was included in the study.

Authors allege, “As such, the Institute of Medicine has labeled EDs as ‘the Safety Net of the Safety Net . . . the provider of last resort for millions of patients who are uninsured or lack adequate access to care from community providers.’ Among all EDs, the Centers for Disease Control and Prevention further identified a subset as safety-net EDs because these EDs provide a disproportionate share of services to Medicaid and uninsured persons.”

Investigators classify EDs as safety-net facilities when they give more than 30 percent of total ED visits to persons with Medicaid. Almost 30 percent of total ED visits may come from uninsured individuals, or a combined Medicaid and uninsured patient population is higher than 40 percent. Having scrutinized the annual U.S. census estimates, experts calculated the visit rates. It was noted that between 1997 and 2007, total annual visits to U.S. EDs heightened from an estimated 94.9 million to an estimated 116.8 million. An increase of 23.1 percent was observed. It was ascertained that this increase almost doubled than what was anticipated from population growth during this period.

Scientists share, “One of the nation’s most severe recessions started in 2008, and with record job losses in 2008 and 2009, an estimated additional 5.8 million Americans be¬came uninsured and an estimated 5.4 million enrolled in Medicaid and SCHIP (State Children’s Health insurance Program). 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. 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.”

Between 1997 and 2007 visit rates to ED heightened from 352.8 to 390.5 per 1,000 persons. Scientists observed that the number of ED visits increased, but the number of EDs available to the U.S. population decreased by 5 percent during this period. The U.S. within the age group of 18 to 44 years and from 45 to 64 years seemed to report the highest elevation in ED visits. The number of adults with Medicaid visiting ED possibly rose between 1999 and 2007 from 693.9 to 947.2 visits per 1,000 enrollees.

No significant change in ED visit rates were registered by adults with private insurance, Medicare and those who were uninsured. In individuals with Medicaid, the ED visit rate for ambulatory care-sensitive conditions per 1,000 enrollees seemingly elevated from 66.4 in 1999 to 83.9 in 2007. From 1997 to 2007, median for ED wait times to seek consultation from a physician increased from 22 minutes to 33 minutes. The number of facilities eligible as safety-net EDs heightened from 1,770 in 2000 to 2,489 in 2007. The study has also encompassed latest available data on U.S. ED visits, through 2007. The growing concern among scientists is the reason for this elevation.

The study is published in the August 11 issue of JAMA.