Emergency Medicine

Emergency departments have increasingly become the health care safety net for adults insured by Medicaid

Emergency departments (EDs) must provide care to all regardless of the ability to pay or insurance coverage. Part of the national medical safety net, EDs are often the last resort for the underinsured and uninsured. A new study of ED visits found that visits to EDs have increased significantly since the 1990s, yet the number of EDs has actually declined. In addition, EDs have increasingly become the health care safety net for adults insured by Medicaid. ED visit rates did not increase for the privately insured, uninsured, and adults covered by Medicare.

Researchers from the University of California, San Francisco, analyzed data from a nationally representative sample survey of 340 to 408 EDs to determine the trends in ED visits over a 10-year period (1997-2007). During the study period, annual ED visits increased 23 percent from 94.9 million to an estimated 116.8 million. This increase was nearly double the population-growth increase of 12.5 percent during the same period. At the same time, the number of EDs decreased from 4,114 in 1997 to 3,295 in 2007. Visit rates among patients with Medicaid increased significantly from 693.9 visits/1,000 enrollees in 1999 to 947.2 visits/1,000 enrollees in 2007. However, there were no significant changes in ED visit rates for the privately insured, the uninsured, and those covered by Medicare.

The number of facilities classified as safety-net EDs increased from 1,770 in 2000 to 2,489 in 2007. EDs were considered safety-net facilities if more than 30 percent of visits were Medicaid or self-pay, or if 40 percent of visits were from a combination of Medicaid and uninsured patients. Wait times to receive care also increased from 22 minutes in 1997 to 33 minutes in 2007. The study was supported in part by the Agency for Healthcare Research and Quality (HS15569).

See "Trends and characteristics of US emergency department visits, 1997-2007," by Ning Tang, M.D., John Stein, M.D., Renee Y. Hsia, M.D., M.Sc., and others in the August 11, 2010, Journal of the American Medical Association 304(6), pp. 664-670.

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