Emergency Room Use Still High Despite Mass. Health Reforms

A new report (PDF) finds that even though most Massachusetts residents now have health insurance, the state still has very high rates of emergency room visits.

Many health reform advocates in Massachusetts had thought that achieving near-universal health coverage would reduce emergency department use statewide. But that hasn’t been the case.

The new study, by the non-profit Urban Institute in Washington, D.C., shows that just having insurance doesn’t stop people from going to the emergency room — sometimes simply for routine, non-emergency care.

The likely reason for that: Even people with coverage don’t always have convenient access to health care, according to Anya Rader Wallack, interim president of the Blue Cross Blue Shield of Massachusetts Foundation, which helped fund the report along with the Commonwealth Fund and Robert Wood Johnson Foundation.

“People having a stronger connection with a primary care doctor, people being able to get same-day appointments, and people being able to get after-hours care would potentially make a big difference,” Wallack said.

Unless access to health care improves, Wallack added, many people will continue to treat emergency rooms as a substitute for a primary care doctor.

The report also found that Massachusetts residents who are frequent users of emergency rooms, meaning that they visited an emergency room more than three times in the past 12 months, have the following characteristics:

  • They are sicker and more disabled than the general population
  • They tend to be low-income or have a low level of education
  • They are heavily concentrated in Boston and the southeast region of the state
  • They account for nearly a quarter of annual emergency room visits statewide
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  • bill

    Why don’t they use urgent care clinics? That’s exactly why they exist. The wait in Urgent Care Clinics is usually minutes, not hours. They treat patients like humans. They’re not that expensive even if you don’t have coverage. I’m not in the healthcare field, and this isn’t urgent care promotion – it’s a question that policy-makers should have an answer for.

  • HV

    While I agree that urgent care clinics should be utilized when possible, the fact is that many of these clinics are located in hospitals, and they often bill insurance carriers at the ER rate.

  • rw

    I’ve had positive experiences using the after hours urgent care at my medical group. All I had to do was call and they would give me an appointment time to come in with minimal waiting time…even on the weekend.

    It would be really great if there were more after hour urgent care clinics available on-site, near ER’s to divert non-life threatning cases.

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