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US emergency department costs: no emergency
P H Tyrance1, D U Himmelstein, S Woolhandler
1Harvard Medical School, Cambridge, MA, USA.
American Journal of Public Health
|November 1, 1996
Summary
Emergency department (ED) overuse is perceived as a major cost driver, but this study shows EDs account for a small fraction of US health expenditures. Cost shifting to the insured for free care is minimal, and limiting ED access may harm vulnerable populations.
Area of Science:
- Health Economics
- Public Health Policy
- Healthcare Management
Background:
- High medical care costs in the US are often attributed to emergency department (ED) overuse.
- Managed care organizations and policymakers consider limiting ED use a key cost-containment strategy.
Purpose of the Study:
- To quantify the actual cost associated with emergency department (ED) utilization.
- To assess the extent of cost shifting from uninsured individuals to the insured population for ED services.
Main Methods:
- Utilized data from the 1987 National Medical Expenditure Survey, encompassing approximately 35,000 individuals in 14,000 households.
- Analyzed ED-associated and other medical care costs for the US civilian, noninstitutionalized population.
Main Results:
- In 1987, total ED expenditures were $8.9 billion (1.9% of national health expenditures).
- The uninsured bore 47% of ED costs, with free care covering only 10%; hospitalization costs initiated by ED visits for the uninsured were $3.3 billion.
- While Whites constituted 75% of ED costs, expenditures for poor and near-poor individuals represented only 0.47% of national health costs.
Conclusions:
- Emergency department (ED) use represents a minor portion of overall US medical care costs.
- Cost shifting to cover free ED care for the uninsured is modest.
- Restricting ED access is unlikely to yield significant cost savings and may disproportionately affect minority and low-income groups who rely on EDs for outpatient care.