While emergency department use by the uninsured remains an ongoing concern, a new study has found that ED overuse by insured patients is also a problem, at least in California. Researchers with the California HealthCare Foundation (CHCF) found that patients with chronic illnesses, in particular, made medically unnecessary visits to emergency departments. These patients had a positive image of ED care, and felt they had nowhere else to go, given that their primary care doctor was closed or couldn't offer a same-day appointment. Many hadn't gotten enough advice on how to handle their sudden medical issues. While physicians treating these patients usually encouraged them to get in contact if they had a problem, the patients often had trouble reaching their doctors after business hours. The problem was also particularly acute among patients with Medi-Cal, the state's program for the poor. Medi-Cal patients were more than twice as likely to have unnecessary ED visits as privately insured patients, which researchers attribute to problems with access to preventative and primary care. According to prior CHCF research, more than half of the state's physicians aren't accepting Medi-Cal.

For details and stats from the study:
- see this CHCF release [1]
- review the CHCF report [2], "Overuse of Emergency Departments by Insured Californians" (.pdf)

ALSO: Other research has found that U.S. communities with more uninsured, immigrant or Hispanic residents usually show lower levels of ED use. Release [3]

PLUS: A Florida hospital ED routes less-sick patients to clinics. Article [4]