Uninsured don't use ER more than insured, but Medicaid patients do

People without insurance were about as likely to use the emergency room as those with private health insurance in 2007, with utilization rates only a few percentage points higher, according to a new data brief by the Centers for Disease Control and Prevention.

The data contradict a common view that ERs are dominated by the uninsured, but in a sense, the myth is not far off: Medicaid beneficiaries, who would be uninsured without the public program, were much more likely to use the ER in a 12-month period and to have had multiple visits than the uninsured and privately insured. That's true across all age segments but most significant among 45- to 64-year-olds, where Medicaid beneficiaries used ERs at more than double the rate of others. The difference was almost as significant in the 18- to 44-year-old age segment.

Other common perceptions hold up: It is the oldest, sickest and poorest who used ERs the most in 2007, and emergency departments were, in fact, more overcrowded than in the past, with longer wait times. That's because demand for emergency services has climbed in recent decades, while the number of U.S. emergency departments has fallen. A big portion of the U.S. population, about one in five, had at least one ER visit in a 12-month period, but the rate exceeds one in four among people age 75 and older.

The brief, released by the CDC's National Center for Health Statistics, is based on 2007 data from several sources. Other findings include:

  • Having a regular doctor did not make a difference in whether people had at least one ER visit in a 12-month period--except among patients 65 and older, who were more likely to have had an ER visit if they had a usual source of medical care.
  • About 10 percent of ER visits were deemed non-urgent in 2007, with the uninsured and Medicaid beneficiaries slightly more likely than the insured to have had ER visits triaged as non-urgent. The NCHS data brief did not consider the differences enough to associate health-insurance status with ER visits being triaged as non-urgent.
  • People below the poverty line were about twice as likely as those with incomes at least four times the poverty level to use the ER at least once in a 12-month period.
  • Non-Hispanic black people were more likely to have had an ER visit--with about 25 percent of that population using the ER at least once in a 12-month period. Hispanic people had the lowest utilization rate, at less than 20 percent of the population.

To learn more:
- read the NCHS data brief
- read a USA Today report on the data
- check out this press release

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