70% of ER visits unnecessary for patients with employer-sponsored insurance

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More than 70 percent of emergency department visits from patients with employer-sponsored insurance coverage are for nonemergency conditions or conditions preventable through outpatient care, according to a new report from Truven Health Analytics.

"The inappropriate use of ED services is growing, resulting in care that is more costly and lacks continuity," the report states, noting that people covered by private insurance are just as likely to overuse an ED as uninsured patients.

The study examined insurance claims data for more than 6.5 million emergency room visits made by commercially insured individuals under age 65 in 2010, according to an announcement. Only 29 percent of those patients required immediate attention in the emergency room.

"Inappropriate use of emergency department services has become a major source of healthcare system waste," John Azzolini, director of practice leadership at Truven Health Analytics, said in the announcement.  "Conventional wisdom has previously suggested that this issue was confined to the Medicaid, Medicare and uninsured populations, but our new research shows that the privately insured population's use of the ER is avoidable approximately three quarters of the time."

The research suggests that for younger patients, the rate could be reflective of "overly anxious" parental behavior and an underlying shortage of after-hours pediatric care. The top three reasons for ED visits were respiratory and chest symptoms, abdominal and pelvic symptoms and "general" symptoms. The overall ED visit rate for females was 17 percent higher than males. Females also showed a higher percentage of nonemergent visits and a lower percentage of emergent visits. 

To learn more:
- see the research from Truven Health Analytics

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