Colorado Emergency Department Use is Up, but Study Finds Surprises About Who's There and Why
FOR IMMEDIATE RELEASE
Denver, CO – More than one in five Coloradans rely on hospital emergency rooms or departments (EDs) for at least part of their medical care, but contrary to popular belief, the uninsured are not the ones most likely to turn up at the door, says a new report from the 2011 Colorado Health Access Survey (CHAS). That finding, along with another showing that a large percentage of ED visits are not for emergencies, points to challenges for Colorado in improving access to health care and lowering costs.
Paralleling national trends, Coloradans' use of EDs is increasing. Findings from the CHAS show that in 2011, nearly 1.2 million Coloradans (22.3%) visited an ED at least once in the preceding year, up from 1 million (20.2%) in 2008-09. In an unexpected finding, Coloradans without health insurance had one of the lowest rates of usage – 21% – slightly above that of Coloradans with private health insurance coverage.
Individuals insured by Medicaid and Medicare had much higher ED use rates – 40% and 30%, respectively. This may be, in part, because the population covered by Medicaid mirrors the populations who reported higher use of the emergency department: young children, older adults, and people with disabilities or those in poor health. But Coloradans covered by Medicaid also reported more often than other insured individuals that doctors wouldn't accept their insurance (28%), another possible factor in their higher ED usage rate.
EDs are the most expensive place to get outpatient health care, so it is concerning that many Colorado ED visits are for non-emergencies. The CHAS found the rate in Colorado to be much higher than national estimates. More than four in 10 Coloradans (44.1%) who visited an ED in the past year reported that their last visit was for a condition that could have been treated in a doctor's office or clinic. Nationally, one-quarter of all acute-care outpatient visits in the nation now take place in emergency departments, according to a 2010 study published in Health Affairs. As well, of the so-called "frequent fliers" – individuals who visited an emergency department three or more times during the year – 43.1% reported that their last ED visit was for a condition that could have been treated by a regular doctor if one had been available.
Asked why they went to the ED for a non-emergency, Coloradans reported these reasons:
• 79% said they needed care after physician office hours
• 63% reported they weren't able to get an appointment as soon as they needed it
• 45% said the ED was more convenient.
The high ED use by Medicaid patients has state leaders worried, particularly since higher enrollments are expected from the federal health care reform law.
"Emergency Department use is a complex issue. The CHAS findings give us information and raise some necessary questions. We have to examine and address the availability and affordability of acute care for both insured and uninsured Coloradans," said Ned Calonge, MD, President and CEO of The Colorado Trust. "EDs are an important part of our health care system and we must give careful consideration to how they should be used if we want to improve health care and lower costs."
Other findings about emergency room use from the 2011 CHAS include:
- Underinsured Coloradans - those with health insurance but who still spend more than 10% of their income on medical expenses - used the ED at a rate of 30%, more often than uninsured individuals (21%) or Coloradans with private insurance (19%).
- The highest rates of ED use were reported for young children and adults age 65 years or older, people with disabilities or in poor health, non-Hispanic Blacks and individuals with the lowest incomes.
- ED visits were lowest (12%) in the mountain resort counties of Eagle, Garfield, Grand, Pitkin and Summit, and highest in Mesa County (32%). These differences likely are linked to patterns of income, insurance coverage and demographic characteristics.
The CHAS report suggests several policy and health systems implications for the growing use of the ED:
- Care coordination for Coloradans with poor health status and multiple needs
- Barriers to obtaining care, such as long wait times for appointments and lack of providers willing to see Medicaid patients
- Additional lower-cost options for care after regular office hours
- Support for patients in navigating the health care system and choosing where to get care
The 2011 Colorado Health Access Survey is a program of The Colorado Trust and is administered as a random-sample telephone survey of more than 10,000 Colorado households. The Colorado Health Institute manages the data collection and analysis. The Colorado Trust has committed more than $4.5 million to conduct the CHAS every other year through at least 2017 to provide information needed to help policy, health care, business and community leaders more fully understand health challenges in Colorado.
To learn more about the CHAS, visit www.COHealthAccessSurvey.org.
The Colorado Trust - www.coloradotrust.org - is a grantmaking foundation dedicated to achieving access to health for all Coloradans.