Reasons for Emergency Room Visits Vary by Health Insurance

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A HealthCare.com evaluation of federal data examines emergency department statistics related to diagnoses, payer types, costs, and income level.

Medical insurance type plays a task in the explanation for an emergency department visit, in keeping with evaluation by HealthCare.com.

The research takes a have a look at federal data on emergency department visits in 2018 and finds the 4 payer types—private, Medicare, Medicaid, and self-pay—are differentiators for trips to the ER.

Among the many top 15 treat-and-release diagnoses, the 4 payer types have in common just six conditions: nonspecific chest pain, abdominal pain/diarrhea, superficial injury, musculoskeletal pain, urinary tract infections, and sprains and strains.

Meanwhile, five conditions behind treat-and-release emergency department visits are among the many top 15 for less than one payer type. Headaches are among the many top 15 for personal insurance, whereas teeth and gum disorders are among the many top 15 for self-payers, chronic obstructive pulmonary disease is among the many top 15 for Medicare, and pregnancy nausea and ear infections are among the many top 15 for Medicaid.

Essentially the most common treat-and-release ER visits for all payers were for abdominal pain, respiratory infection, and chest pain.

Hospitals within the U.S. saw 143.5 million emergency department visits in 2018, with 14% of visits leading to hospital admission and 86% leading to treatment and release. Nonetheless, emergency department visits by privately insured and self-pay patients declined from 2009-2018, while visits by those insured by Medicare and Medicaid increased, in keeping with HealthCare.com.

A part of the explanation for the changes in variety of ER visits might be because of the differing costs of a visit based on insurance type.

Additional evaluation by HealthCare.com of 2017 federal data finds Medicare patients have a median cost of $660 per visit, followed by private insurance at $560, self-pay at $460, and Medicaid at $420.

Income level can also be an element, with the research uncovering that patients in the bottom income quartile visit ERs at a rate of 641 per 1,000 people, in comparison with 281 per 1,000 people for the very best income quartile.

In terms of outcomes, it’s clear that having insurance allows individuals to be more willing to search out vital care and make a visit to the emergency department.

“We all know that expanding medical health insurance leads to higher health and financial security for families,” Ben Sommers, HHS deputy assistant secretary Ben Sommers told HealthCare.com. 

“The emergency department is one area where disparities can show up prominently. That is why the department’s focus has been ensuring that we now have pretty much as good coverage and access as we are able to, and we have seen that in near historic lows within the uninsured rate previously yr, and the record high of individuals enrolled in Reasonably priced Care Act coverage and Medicaid. For those who haven’t got coverage you will face big bills and risk not getting the care you would like.”

Jay Asser is an associate editor for HealthLeaders.

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