Insurance Up, but Emergency Visits Up Too

Blog Note:
I’ve become a devotee of NPR’s Planet Money – which starts each podcast off with a number – and then dissects the implications of that number.  I think that’s a great idea – so today, I’ll inaugurate beginning each post with a relevant statistic.

Today’s Managing Health Care Cost Number is…..


That’s how much emergency department use in Massachusetts has risen over the past 4 years.  The Division of Health Care Policy and Finance released this report at the end of June, and the Boston Globe reported the results on July 4.    The total number of ED visits in the Commonwealth went up to almost 3 million. 

Emergency Department Visits in Massachusetts, 2004-2008

Massachusetts has the lowest rate of uninsured in the country – so many figured this would help decrease emergency department utilization.

As Nancy Turnbull pointed out in the Globe, the rate of health insurance among Massachusetts residents has been high for some time. Therefore, the percentage of those going to the ED who were uninsured was low even before we passed health care reform – so any change in the number of uninsured was not likely to have a big impact on ED utilization.  ED utilization was increasing before health care reform, and the increase has continued unabated since we passed health care reform. 

The real problem is that there is a lack of access to less-expensive alternatives to the emergency department.  Many Massachusetts residents have a hard time finding a primary care physician. That’s especially true for healthy people who have acute illnesses and haven’t already developed a primary care relationship.   We’ll need retail clinics and non-physician providers (nurse practitioners and physician assistants) to create enough access so that ED rates don’t keep on going up.  We also need tools (like nurse lines) to allow patients to make the best decision about when it’s necessary to go to an emergency department.

Health care reform has improved access to health insurance in Massachusetts.  We now need to make substantial improvements to the delivery system if health care reform is to fulfill its promise.