ER vs. Doctor’s Office, and Other Links

Do low-income patients go to the emergency room rather than a doctor’s office because they prefer the emergency room?

Patients in Medicare Advantage plans got expensive balloons and stenting to clear coronary arteries at a rate 31 percent lower than patients in traditional Medicare, and angiography procedures were 36 percent lower. But geographical variation is still large and we don’t know if this was good for patients.

45% of the nation’s nearly 28 million uninsured workers are employed by large firms, subject to the ObamaCare mandate.

Comments (18)

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  1. JD says:

    “Do low-income patients go to the emergency room rather than a doctor’s office because they prefer the emergency room?”

    It is often hard for Medicaid recipients to get primary care because of the long wait times (months). This is the result of an increasing number of physicians refusing to accept new Medicaid patients due to low reimbursement rates.

    • Dewaine says:

      While raising reimbursement rates could help alleviate this problem (while causing others), there is now more to it. Now, low-income consumers are attached to this type of service and it will take time for many to adjust to traditional service. This may require them shouldering more of the burden of ER services.

  2. JD says:

    Third party payment leads to higher cost because the consequences are less direct. People respond to incentives. Perverse incentives lead to perverse outcomes.

    • Dewaine says:

      Right. Unfortunately, when that requires scaling back benefits that were foolishly doled out, nobody wants to be the one to end the gravy train.

  3. Ken says:

    That last point is especially important since the Obama Care apologists are saying the delay in the employer mandate won’t affect anything.

    • JD says:

      Exactly, Ken. It’s amazing how much misinformation is provided by “experts”. No wonder this country is so divided.

      • Dewaine says:

        If we can’t believe the “experts”, who can we believe? Both sides think that they are operating based on reliable information, but that can’t be true. We can’t all go through and scrutinize each study, we have to take someone’s word for it. We need them to come to a consensus. Unfortunately that will be extremely difficult given the ideological entrenchment of both sides. We’ll just become more bitter and divided.

  4. JD says:

    “45% of the nation’s nearly 28 million uninsured workers are employed by large firms, subject to the ObamaCare mandate.”

    Good to know. We knew there was something misleading about those reports that said the delay would make no difference.

  5. Sammy says:

    ‘Do low-income patients go to the emergency room rather than a doctor’s office because they prefer the emergency room?”

    -Emergency rooms are the worst. Long waits and screaming kinds do not make for a pleasant atmosphere.

  6. Randall says:

    “Do low-income patients go to the emergency room rather than a doctor’s office because they prefer the emergency room?”

    From my experience, it is not because they prefer the long wait and high expense of the emergency room. It is that they usually do not know any better and wait till the last minute (justifying an emergency)or overreact to everything and therefore, believe everything is an “emergency” that only the emergency room can handle.

    Higher education, better family and budget management and regular doctor visits would really change this situation.

    • Dewaine says:

      This is definitely true. How do we fix it?

      Education and “hand-holding” surely can improve these outcomes, although that will come at a price. I think that a cheaper, more effective way to change behavior is to have financial disincentives in place to discourage inappropriate ER use (i.e. make people pay for it, as opposed to, say, Medicaid).

  7. Linda Gorman says:

    The Robert Wood Johnson Foundation published a study a few years ago on why people covered by Medicaid use the ER when they all have primary care physicians.

    In a nutshell, it concluded that the ER is open 24/7, all the tests are in one place, it doesn’t cost any more to go there, and you don’t need an appointment.

    Rather than blathering on about primary care appointments for people who often live such chaotic lives that they don’t necessarily know what they’ll be doing at 10:45 am a week from now, perhaps Medicaid officials should consider bringing urgent care centers into the fold, at least in the relatively more enlightened areas that allow them.

  8. Devon Herrick says:

    Do low-income patients go to the emergency room rather than a doctor’s office because they prefer the emergency room?

    We should not dismiss ingrained behavior. People may patronize ERs because they don’t have a usual source of care (other than the ER). The reason they have no other usual source of care may be due to the fact they’ve never bothered to locate doctors on their health plan or who will see them. Even though most people find the ER very inconvenient, someone who have navigated the ER numerous times in the past may prefer it to navigating the process of locating a doctor, exchanging insurance information and scheduling an appointment.

    When I worked at a hospital years ago, my accounting assistant (who previously worked in our HR department) told me she had talked to some nursing assistants who told her they didn’t want to participate in the employee health plan (which had minimal contributions and low co-payments). The reason the nurses gave was they already has a health plan; they planned to go to Parkland Memorial (emergency room) whenever they had a problem. This made absolutely no sense. But it was ingrained behavior.

    • John says:

      It’s also important to consider undocumented immigrants who have no other choice really, use other names and addresses, and inflate the number of hospital care vs ambulatory care.

  9. John says:

    “They perceive it as less expensive, more accessible, and of higher quality than ambulatory care.”

    I wonder why they perceive it as less expensive. I can see the argument of it being quicker, but less expensive??…

    • Dewaine says:

      I think they’re referring to people who can get the government to pay it for them.

  10. Hoads says:

    Hospitals have tried various tactics to reduce non-emergent ER use but apparently,their efforts are often stymied by federal regulations. I’ve found it frustrating that government and various healthcare politicos cite overuse of ER as a main culprit of our expensive healthcare system when that is bunk! However, the stalemate of what to do to redirect non-ER patients to urgent care or ambulatory cre is also very much burdened by the threat of legal liability. And there again, , Obamacare fails to address one of the biggest culprits of inefficiency in our healthcare system.