Sicker Patients Seeking Emergency Care

The majority of those EDs that closed were in urban areas. Overall, the report said, since 2001, the average travel distance to the nearest ED across the state changed little.

However, many of those hospitals that maintained emergency services increased their number of ED treatment bays. There were 4,994 ED beds statewide in 1996, but 6,310 ED beds in 2007, an increase greater than that of the population (15%) in that period. Hospitals that did not close expanded their emergency bed capacity to help meet the increased demand.

"Overall, there was an 8% rise in ED beds between 1996 and 2001and a 17% rise between 2001 and 2007," the report said, adding that this suggests EDs "are considered an essential service and that most hospitals have been able to manage external pressures in order to continue to offer ED services."

The report also found wide regional variation in emergency department capacity versus need throughout the state. For San Francisco, Fresno, Santa Clara, and Contra Costa counties, ED capacity outpaced demand for emergency care. In Sacramento, Los Angeles, and Kern counties, capacity kept up with demand. However, in San Bernardino, Riverside, and San Diego counties, demand exceeded increases in capacity.

Robbin Gaines, who is California HealthCare Foundation program officer, could not speculate on why there was so much variation between the counties, saying a more detailed analysis was necessary to determine if reimbursement or a mix of patients might be influential.

However, she noted, the lesson from the report is that "Emergency care is not 'one size fits all.' While statewide the number of ED beds has increased, there is substantial variation in ED systems across counties."