The underlying factors

As the system as a whole struggles with this issue, we must take a step back and understand which factors are driving insured patients to go to the ER rather than their primary physician or clinic. Here are a few:

Rising out of pocket costs for individuals prompt many to take a "wait and see" approach when experiencing medical issues in an effort to avoid incurring a co-pay or a bill that would strain their finances. But when left untreated, even seemingly minor issues can escalate quickly, causing symptoms that become a medical emergency, or may cause individuals to believe that they are experiencing one. In many cases, the situation could have been addressed by a primary physician at a fraction of the cost.
Gaps in coverage and confusing pricing and policies can leave individuals feeling hesitant to actually use their health plan for primary care due to the fear of having to make an upfront payment, such as a co-pay. In such situations, some individuals may turn to an emergency room for care, where in most cases they will be treated without being asked for an upfront payment. The unfortunate outcome is that such visits will end up costing them much more in the long run.
A lack of affordable preventive and essential care is a particularly vexing issue, as we all know an ounce of prevention is worth a pound of cure. Routine visits not only help catch issues before they escalate into serious condition, they also help educate patients on best practices for managing their health and well-being, especially when it comes to managing chronic conditions and understanding their symptoms, including when to seek emergency care. In the long run, a serious condition or mismanaged chronic condition will cost everyone involved much more than a few preventative appointments and essential screenings.
Little to no education about what warrants a visit to the ER and the available alternatives for care. Let's face it, when someone is in pain or worried enough to go to the ER, they're probably not in the right mindset to begin researching after-hours care at their regular clinic, nurse hotlines or urgent care options in their area.

While this is by no means an exhaustive list of causes, it does begin to illustrate the multiple factors that contribute to ER overuse, and why it has become such a complicated issue to untangle.

Instant Insights /

Emergency room overuse – and what benefits professionals can do about it

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