ER: The Gateway to Hospitalization

A RAND Health study found that hospital emergency rooms are now the point of access for nearly half of all hospital admissions in the U.S. and account for almost all of the growth in admissions between 2003 and 2009. During that time, hospital admissions grew only 4% — not even keeping pace with population growth. But ER-related admissions jumped 17%. (

Why this is important: about half of the newly insured under ObamaCare will get insured by Medicaid, and Medicaid patients use the emergency room twice as often as privately insured patients. Also, hospitals are buying doctors, who will be pressured to admit patients once they get to the emergency room.

Comments (14)

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  1. Slim says:

    “Also, hospitals are buying doctors, who will be pressured to admit patients once they get to the emergency room.”

    – this could be a huge issue. People only need to be omitted if their health requires it, not to get unnecessary tests and spend money.

  2. Tim says:

    Well, for hospitals, this isn’t all that bad, is it? Of course they wouldn’t mind accepting patients in the expensive ER that aren’t there due to a true emergency.

  3. Ron says:

    This is such a bad and troubling trend. This is also threatening the traditional doctor-patient relationship.

  4. JD says:

    I wonder if this also has to do with decreases in purchasing power for some groups and income stratification coupled with the ability to “skip out on the check” in the ER. Is that everywhere? Or just in a few States? The incentive is there, why wouldn’t you use the ER, a service that allows some to refuse to pay?

  5. Nigel Molesworth says:

    The increased use of the ER could be detrimental to people who actually need emergency care, which could increase drunk driving deaths, ect.

  6. William Jones says:

    This is a huge issue with the new Obamacare system, because if the policies increase the usage of the ER, people will be more likely to use the ER, which (after a period of time, depending on abuse) will create a increase in foreclosures of hospitals.

  7. Dewaine says:


    Definitely. I wonder what impact that would have on the personnel composition of hospitals? Would it result in a higher percentage of paramedics and nurses employed or maybe result in the evolution of a more mobile, more flexible doctor/nurse/paramedic hybrid?

  8. August says:

    The RAND report says that part of the change is also caused by other doctors changing their behavior:

    “office-based physicians are directing to EDs some of the patients they previously admitted to the hospital”

    “office-based physicians increasingly rely on EDs to evaluate complex patients with potentially serious problems, rather than managing these patient themselves”

  9. Baker says:


    Don’t forget that there are also other trends contributing to the increase in ED use.

    “The vast majority of patients who seek care in an ED walk in the front door and leave the same way… ambulatory patients do not use EDs for the sake of convenience. Rather, they seek care in EDs because they perceive no viable alternative exists, or because a health care provider sent them there”

    “The principal reason patients visit EDs for non-emergent outpatient care is lack of timely options elsewhere.”

  10. August says:


    Right. But wouldn’t changing doctor behavior may be an better short term option than fixing the entire system?

  11. Baker says:


    We’re not trying to fix the healthcare system because it is easy, but because it is hard. We will do it because the challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win.

  12. Pete says:

    Just because there is a correlation between Medicaid recipients and ER visits doesn’t mean causation.

  13. Jordan says:

    @Pete, True — but we all know there is a significant lack of access for Medicaid recipients, which generally leads to less preventative steps. Medicaid reimbursement rates, if they stay at current levels, will continue to force people into ERs under mandatory coverage.

  14. Linda Gorman says:

    If the problem is a lack of access for Medicaid patients, why is it that the uninsured use the ED at about the same rate as private payers?