Nearly three-quarters of the patients who walked into hospital emergency departments (EDs) in New York City in 1998 did so to get treatment for conditions that were either not emergencies or could have been treated in a primary care setting, according to research conducted by John Billings, Nina Parikh, and Tod Mijanovich of New York University's Health and Public Service Research Institute. Another 7 percent sought treatment for problems that may not have become emergencies if they had been addressed earlier. These figures exclude patients that were admitted to the hospital.
Going to the emergency department for a nonemergency is not a practice confined to a single demographic group, the research shows. Although there are differences across ethnic groups and insurance categories, use of the ED for nonemergencies is higher than desirable among all New Yorkers. The high use of EDs for nonemergency conditions may indicate that New York's primary care system is not meeting the needs of its residents. The lack of adequate primary care causes many people, especially those with low incomes and no health insurance, to wait longer than they should to get care. By using the emergency department instead of visiting a doctor regularly, patients forgo the benefits of continuity in care and end up using costlier services.
Changing the way people use the ED will require improvements to the primary care system, the authors argue. To begin with, the system needs to be more responsive to patients, taking into account how they decide when and where to seek care. In addition, primary care clinics must be better rewarded for providing a lower-cost alternative to ED use and for preventing emergency situations from developing. Without stronger incentives and higher payment rates, there will be fewer sources of primary care in the future.
Billings and colleagues' research has been published as three Commonwealth Fund issue briefs: Emergency Department Use in New York City: A Substitute for Primary Care?, Emergency Department Use: The New York Story, and Emergency Department Use in New York: A Survey of Bronx Patients. In conducting their work, the authors developed a new method of analyzing emergency department use. Previously, it had been possible to track trends in overall ED usage, but not to understand the extent of true “emergencies” requiring the personnel and equipment available in an emergency department.
Facts and Figures
- Nonemergent visits to EDs are especially common among fee-for-service Medicaid beneficiaries living in low-income neighborhoods like Central Harlem and the South Bronx, as well as in some middle-income areas of Queens and Staten Island, where Medicaid patients may be isolated from Medicaid providers.
- Rates of ED use were high for both children and adults: nearly 42 percent of both children and nonelderly adults used the emergency department.
- Nearly 8 percent of children and 7 percent of adults required ED care that was potentially preventable.