Reasons for Emergency Room Visits Vary by Health Insurance

A HealthCare.com analysis of federal data examines emergency department statistics related to diagnoses, payer types, costs, and income level.

Health insurance type plays a role in the reason for an emergency department visit, according to analysis by HealthCare.com.

The research takes a look at federal data on emergency department visits in 2018 and finds the four payer types—private, Medicare, Medicaid, and self-pay—are differentiators for trips to the ER.

Among the top 15 treat-and-release diagnoses, the four payer types have in common just six conditions: nonspecific chest pain, abdominal pain/diarrhea, superficial injury, musculoskeletal pain, urinary tract infections, and sprains and strains.

Meanwhile, five conditions behind treat-and-release emergency department visits are among the top 15 for only one payer type. Headaches are among the top 15 for private insurance, whereas teeth and gum disorders are among the top 15 for self-payers, chronic obstructive pulmonary disease is among the top 15 for Medicare, and pregnancy nausea and ear infections are among the top 15 for Medicaid.

The most common treat-and-release ER visits for all payers were for abdominal pain, respiratory infection, and chest pain.

Hospitals in the U.S. saw 143.5 million emergency department visits in 2018, with 14% of visits resulting in hospital admission and 86% resulting in treatment and release. However, emergency department visits by privately insured and self-pay patients declined from 2009-2018, while visits by those insured by Medicare and Medicaid increased, according to HealthCare.com.

Part of the reason for the changes in number of ER visits could be due to the differing costs of a trip based on insurance type.

Additional analysis by HealthCare.com of 2017 federal data finds Medicare patients have an average cost of $660 per visit, followed by private insurance at $560, self-pay at $460, and Medicaid at $420.

Income level is also a factor, with the research uncovering that patients in the lowest income quartile visit ERs at a rate of 641 per 1,000 people, compared to 281 per 1,000 people for the highest income quartile.

When it comes to outcomes, it's clear that having insurance allows individuals to be more willing to seek out necessary care and make a trip to the emergency department.

"We know that expanding health insurance leads to better health and financial security for families," Ben Sommers, HHS deputy assistant secretary Ben Sommers told HealthCare.com. 

"The emergency department is one area where disparities can show up prominently. That's why the department's focus has been making sure that we have as good coverage and access as we can, and we've seen that in near historic lows in the uninsured rate in the past year, and the record high of people enrolled in Affordable Care Act coverage and Medicaid. If you don't have coverage you'll face big bills and risk not getting the care you need."