Unnecessary Emergency Room Visits

Emergency room visits cost insurance providers a fortune, and quite often they’re unnecessary.

In an age where scrutiny of the healthcare system is perhaps at an all-time high, there’s some less-than-great news being reported from the folks that keep score. According to a new scientific study, 71 percent of all emergency room visits by patients with employer-sponsored health insurance are essentially unnecessary.

The Claim

The study, which was performed by Truven Health Analytics, set out to look at the emergency room habits of people with employer-sponsored healthcare. In debates about healthcare in the US, those who use government-sponsored forms of healthcare are often receive blame for congesting emergency rooms and putting stress on hospital resources. Yet the results of this most recent study suggest that employer-insured individuals are just as likely to visit the emergency room in situations when they don’t really need to.

The Dirty Facts

In order to establish a proper context for this study, the researchers focused on data from 6.5 million emergency room visits made by employer-insured patients during 2010. Their findings were somewhat sobering. Of all of these emergency room visits, only 29 percent resulted in emergency treatment being administered. In a perfect world, a full two-thirds of all emergency room visits by commercially-insured patients in the US could have been avoided in 2010. Of the 71 percent of patients who didn’t require medical care, 24 percent didn’t require immediate care. A full 41 percent were administered care that could’ve been performed in a setting other than the emergency room. Additionally, six percent of commercially-insured patients who visited the emergency room were treated for issues that would have been avoidable if they had received proper primary care to begin with.

The Dirty Cost

Emergency room visits are hardly cheap, and the excessive misuse of the emergency room has come with a big price tag attached. The authors of this study estimated that if only 10 percent of unnecessary emergency room visits were avoided, it would result in a net savings of $18.68 for each of the 24 million insurance enrollees included in the span of the study. That may not seem like much per person. But all tallied up, that’s equal to a savings of $461 million dollars each year!

The Biggest Offenders

When breaking down the study into demographics, the researchers found that women are more likely than men to visit the emergency room, and are also more likely to visit for what turns out to be non-emergency level reasons. However, the most common scenario of an unnecessary emergency room visit involved tomorrow’s leaders – 82 percent of all visits to the emergency room by children 12 months or younger resulted in a non-emergency diagnosis!

For informational purposes only.