Myths and Facts About Emergency Care

Main Points

  • Most emergency patients have health insurance, and the vast majority of them have serious medical problems that are best treated in the emergency department.
  • Emergency care represents less than 3 percent of the nation’s $2.1 trillion in health care expenditures while treating 120 million people a year.
  • The reasons emergency departments are crowded are complicated, but emergency physicians are dedicated to improving everyone’s access to emergency care.
  • Everyone is only one step away from a medical emergency.

Myth:
Emergency departments are crowded because people abuse the system by seeking care for minor problems.

Fact: 
Less than 8 percent of emergency patients are classified by the Centers for Disease Control and Prevention as non-urgent, meaning they need to be seen in 2 to 24 hours, which also does not mean these visits are “unnecessary.” The CDC’s definition of “non-urgent” includes serious conditions, such as bone fractures and bronchitis. These patients wait the longest for care. A 2006 Annals of Emergency Medicine study (Schull) showed that reducing the number of low-complexity patients would do little to reduce emergency department delays for sicker patients, and hence do little to reduce crowding.

Myth:
Emergency department crowding could be eliminated by sending people to urgent care centers and health clinics.

Fact:
The vast majority of people seeking emergency care need to be there, and as the population ages, the need for emergency care will increase. Despite the proliferation of urgent care centers, the number of people seeking emergency care grows every year.

Myth:
The problems facing emergency patients will be solved by the new health care reform legislation.

Fact:
Emergency visits will increase, despite health care reform, as they have in Massachusetts, which enacted universal coverage in 2006. Unfortunately, the new health reform law (H.R. 3590-Patient Protection and Affordable Care Act) does not address the underlying issues that affect ER boarding and crowding.

The CDC says ER visits hit an all-time high of nearly 124 million in 2008 (37-percent between 1997-2008) and emergency departments continue to close, such as St. Vincent’s Hospital in New York (April 2010). While the new health care law contains provisions that will benefit emergency patients, the implementation of the new law will be done by regulations, which have not yet been established, which means the effects of the new law are yet unclear.

Despite prevention and wellness efforts and the efforts to create patient medical homes, people will always face unexpected injuries and illnesses, which need to be treated in an ER. Furthermore, coverage does not necessarily equal access, as proven in the early years of the Massachusetts health reforms.

Myth
:
Emergency departments are inefficient.

Fact:
Because emergency departments are able to tap into all of a hospital’s resources in one place they can do in hours what otherwise would take days if a patient was sent from office to office for testing, specialty expertise and pharmacy. Emergency physicians are experts in diagnosing and treating a wide range of health emergencies, from pediatric to geriatric and from trauma to infection. 

Myth:
Most emergency patients are uninsured, making the emergency departments the primary care resource for uninsured people.

Fact:
Eighty-three percent of emergency patients have some type of insurance, either government (Medicare, Medicaid or SCHIP) or private. The emergency department is a health care safety net for everyone, not just the uninsured.

Myth:
Pediatricians are better than emergency physicians at treating childhood emergencies.

Fact:
Emergency physicians receive significantly more training in treating childhood emergencies than pediatricians do, and treat more than 21 million children in emergency departments every year. The vast majority of children have positive outcomes without being admitted to the hospital.

Myth:
If everyone had health insurance and access to primary and preventive care, ER crowding would end.

Fact:
Emergency visits will increase, despite health care reform, as they have in Massachusetts, which enacted universal coverage in 2006. A 2006 Annals of Emergency Medicine (Kelly Hunt) study found little difference in emergency department use between people who do or do not have health insurance and a primary care physician.

Myth:
We all share the cost of treating the uninsured in emergency departments.

Fact:
Cost sharing occurs, but uncompensated care has closed hundreds of emergency departments in the United States. A significant burden for treating the uninsured also is borne by emergency physicians, who provide an average of $138,000 in uncompensated care every year, and by the uninsured themselves, who are charged the highest rate for care. In fact, uninsured patients pay a higher proportion of emergency department charges than Medicaid patients (Annals of Emergency Medicine, Renee Hsia, 2007. The Hsia study showed that overall less than 50 percent of all emergency department charges are reimbursed.

Myth:
Emergency medical care is too expensive.

Fact:
Emergency medical care accounts for only 3 percent of all health care spending in the United States and treats 120 million people a year.

For more information, visit www.ACEP.org.

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