Why denying ER care to patients is bad policy

It’s commonly thought that rising emergency department expenditures could be curtailed if we could eliminate non-urgent visits.

In Washington state, for instance, lawmakers are proposing limits to the number of times Medicaid recipients can go to the ER.

But what, exactly, is a “non-urgent” visit?  And how can patients know beforehand what’s urgent or not?

In a recent piece from TIME, emergency physicians Jesse M. Pines and Dr. Zachary F. Meisel takes a nuanced look at the issue.  From a patient’s standpoint,

the perception of urgency after reviewing a medical chart is often different from the perception of the person seeking emergency care. Imagine a young woman with an uncomfortable urinary-tract infection on a Saturday. It is very likely that to her the ED visit felt quite urgent, while a policymaker or insurer may conclude that her problem is nonurgent and can wait until Monday when the doctor’s office is open.

And there are studies that show that closing the ER to non-urgent complaints may, in fact, raise health costs:

… for society — for whom the goal is to minimize cost and maximize productivity — the marginal cost of an ED visit is actually lower than that of an off-hours clinic visit while getting after-hours care at an ED is more efficient than missing work to go to a clinic.

Drs. Pines and Meisel argue against blunt solutions, like the one being proposed in Washington state. Denying ER care to patients can lead to unintended consequences, like the aforementioned societal costs, along with the risk of increased malpractice litigation.

Furthermore, by targeting the ER, such policies also miss the true cause of the problem: a profound lack of primary care access.

Kevin Pho is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitter, and LinkedIn.

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