In my opinion (as an ER doctor), the reason for the findings in the Oregon study likely are due to a couple of reason. One is lack of availability of physicians accepting Medicaid. Two is that we live in a society of instant gratification. I can deposit a check on my phone from the kitchen, I can see scores from every football game without waiting for the morning paper, it’s 7pm and I just got off work, I want my health care now!
For a lot of common reasons for ER visits, the expensive part is the diagnosis, the figuring-out-what’s-wrong phase. For example, if the patient presents with abdominal pain, fever, and nausea/vomiting, the labs and examination cost a chunk of change; by the time you figure out it’s a kidney infection, e.g., the additional cost to write a script for antibiotics is pretty nominal. Similarly, the X-rays or other scans to rule out serious injuries cost more than a splint and some stitches.
And, of course, those are the only two ways health emergencies can present. And when someone shows up at an ER gushing blood, they generally treat that right in the waiting room, instead of taking them back to a private or semi-private room where they have sutures and medicine and machines that go “Ping!”
On what planet is going to an ER “more convenient”? If you aren’t having an immediately life-threatening emergency, you are looking at hours and hours of waiting-- likely most of the day or night-- in uncomfortable and unpleasant surroundings.
Because the ER is open 24 hours a day.
I did add “or whatever” 
It’s more convenient than waiting for an appointment with a PCP.
If you can get in to see a PCP within a few days, spending an hour or so at their office is probably a lot more convenient than spending eight or ten hours sitting around the ER.
If “waiting for an appointment” means waiting for weeks or months, you are probably correct. If you can’t even get an appointment because no PCP in your town is willing to accept Medicaid patients, then you are certainly correct that the ER is a better choice than an infinite wait.
Now, what is (was) the case with THESE Medicaid patients? Did they have reasonable access to primary care physicians or not?
Not sure exactly, but I found this in the study -
I know one time I needed a CAT scan and it would take a few days to get an appointment, so my PCP just told me to go to the ER to get it. Which is what I did, because it was only $25 for me. If it would have potentially costs hundreds or thousands of dollars, I probably would have waited for the appointment.
I don’t follow your point here. If you had no insurance and had to pay the full cost yourself, you would have paid hundreds or thousands whether you went to Emergency or waited for a appointment with an outside provider. If you’ve got insurance (private, Medicaid, whatever), your share of the cost usually doesn’t vary all that much based on whether it’s done at the ER or by appointment.
I would think getting it done at the ER is more expensive than an outside provider, no?
Plus you are right, I think I mixed up my points. The fact is even though I had insurance, I still went to the ER for convenience sake, instead of waiting for a few days for an appointment. I was taken care of, diagnosed, and sent on my way in 4 hours, instead of waiting 3-4 days JUST for the scan.
I believe this is incorrect, other than the last part of the final sentence. ERs routinely treat people without insurance for free, for all sorts of minor ailments that PCPs can easily take care of.
I was once at a presentation on Medicaid expansion, and the head of some hospital group said that hospitals did everything they can to get Medicaid-eligible people to sign up for Medicaid so that they could at least get something in payment, but that people couldn’t be bothered. The law (at least in NJ - I’m not sure if this was national or state law) is that hospitals cannot raise the issue of payment before treating people, and once people have been treated they wanted to go home and couldn’t be bothered to step over to the Medicaid-enrollment office, even if located in the hospital.
The thinking is that once these people had available PCP services, they would switch at least some of their ER spending to PCPs from ERs. This was a big selling point of the ACA, and was supposed to account for a lot of savings. Interesting that it hasn’t happened.
For people who don’t have paid sick leave, this is big.
Exactly. I was checking to see if someone mentioned this before I posted but I would think that’s the main reason people go to the ER. I’m actually in Oregon AND on Medicaid so I can tell you it can be a pain in the ass to get an appointment. There’s only one clinic I’m allowed to go to and it’s a 30 minute drive for me one way. And I have NEVER been seen on time there. Normally I don’t get out of there till almost an hour past my scheduled time. Now, since I’m unemployed atm that isn’t a huge deal. But if I have a job where I have to take an hour off JUST for driving to the appointment, not to count the actual appointment time, it’s going to get really inconvenient (if not impossible) fast.
The clinic I go to services pretty much everyone in my county for medical and dental. You’re waiting anywhere from a few days to a few weeks to see someone depending on your luck. I need to get a checkup to renew my BP meds and I called a week ago to get an appointment. The nearest one was in the middle of November in the middle of the day. If I have a job at that point it’s going to have to be cancelled.
Basically if you’re living check to check and working a minimum wage job with little to no paid time off, there’s no way you can see a regular doctor. The emergency room is really your only option. Yeah it sucks sitting there for hours but at least you’ll still be able to pay your rent and buy food for the week.
I’m in Oregon as well and on the Oregon Health Authority’s Medicaid plan. I think a lot of it has to do with availability of doctors. They only see patients so often and you have to wait a few months before you can do your initial visit with the doctor to get in their system. after you get in their system you can kind of get to see them within a few weeks sometimes. The insurance Representatives tell us that if we can’t get in to see the doctor we need to go to the emergency room. If you blow your appointment because you can’t get across town fast enough with the primary care physician you have to pay them $50. A lot of people around here don’t even make $50 a day so even setting up an appointment you can’t guarantee to be at exactly on time isn’t an option. If I’ve got a kid that is sick and the doctor’s going to take 3 weeks to even see the child before they just transfer you off to a specialist where you have to wait 2 months to get into, I’m going to the emergency room.
Oh and I have something else to add to this. It seems like when people ask questions about this they naturally assume that it’s just laziness on the patient that sends him or her to the ER instead of a primary care physician. That’s really not the case. Every time I’ve been in the emergency room I didn’t want to be there and nobody else wanted to be there either. When I was a kid I remember my mother just calling up the doctor before we left and we just showed up and saw the doctor. That doesn’t happen anymore. I’ve made appointments with my primary care physician before only to have to wait a week and a half to see the medical assistant who tells me they can’t help me and I need to see the doctor and have to be rescheduled another two and a half weeks.
I lost a job because I had to go to the doctor. I ruptured my eardrum and blood was pouring out of my ear. I left work to go to my primary care physician who couldn’t see me for 2 weeks for the problem. The next morning I called my employer to let them know what was going on with my ear and they fired me because they would only approve that afternoon off without a doctor’s note and I couldn’t get the doctor’s note because I couldn’t see the doctor. I went to an emergency care clinic to see if I can get treatment there and salvage my job, only to see a medical assistant who said that I needed to go to the emergency room. They sent me a bill a week and a half later for $250 for my appointment at the emergency care clinic. Now that I lost my job I’m on Oregon Health Authority insurance. Now I could actually afford to go to the emergency room but I am deaf in my ear and it is healed on its own I guess. The joys of being a lazy person.