Study debunks idea that uninsured patients overuse the ER

Uninsured people are more likely to avoid care in non-ER settings, according to a new study.

Despite the common perception that the uninsured are more likely to visit the emergency room, new research contends that isn't actually the case. 

Researchers analyzed data on more than 41,000 adults from 2013 and found that uninsured patients visit the ER about as frequently as insured patients, with 12.2% of the uninsured visiting the ER compared to 13.7% of insured patients. Uninsured people were less likely than those on Medicaid to go to the emergency department, as 29.3% of Medicaid enrollees went to the ER for care. 

However, uninsured patients were far less likely to seek other outpatient care and accounted for a fraction of hospital admissions included in the study, which was published in the December edition of Health Affairs. Less than half (41.8%) went to a non-ER outpatient setting when they needed care, and just 3% were admitted to the hospital. Comparatively, more than three-quarters (76%) of insured people visited other outpatient settings, and 7.6% were hospitalized. 

"The uninsured don't use other types of care, such as outpatient clinics or hospitals, as much as the insured do," Katherine Baicker, Ph.D., dean of the University of Chicago Harris School of Public Policy and one of the study's authors, said in an announcement. "This finding may contribute to the notion that the uninsured overuse emergency departments—other patients and providers are more likely to see the uninsured in emergency departments than in other settings." 

RELATED: Uninsured rate climbing among American adults 

The study also reinforces prior research. For example, a study published in the Annals of Emergency Medicine earlier this year found that after the Affordable Care Act was fully implemented, states that expanded Medicaid saw an 8.8% increase in ER visits covered by Medicaid. Meanwhile, the number of ER visits by uninsured people decreased by 5.3%. 

One reason that the uninsured are more likely to eschew care settings beyond the ER is that they can be legally be denied care elsewhere, Baicker and her co-authors wrote. The Emergency Medical Treatment and Labor Act (EMTALA) protects their right to receive care in the ER. 

Uninsured patients may also lack access to other outpatient care settings, may feel stigmatized or may not have a full understanding of how insurance coverage works, which can also prevent them from seeking out non-ER care, according to the study.

Analyzing these trends has significant implications for health policy, the researchers noted. As lawmakers propose significant changes to healthcare law—including rolling back the ACA's individual mandate—a "realistic view" of how different patient populations use healthcare is essential to crafting effective policy, they argued.