Most Vulnerable More Likely to Depend on Emergency Rooms for Preventable Care

People in vulnerable populations — as defined by socioeconomic characteristics — made more preventable visits to emergency rooms than others from 2013 to 2017, according to a U.S. Census Bureau working paper.

The study analyzed census data linked with emergency visit records in the state of Utah. It found that factors including lower income, educational attainment, unemployment, lack of health insurance, lack of access to a vehicle or internet service were associated with a greater number of preventable visits.

There was a clear correlation between income level and the frequency of preventable emergency care visits.

Visits to emergency departments are considered preventable when they are for health conditions that could have been handled in a non-emergency setting or avoided if the patient had adequate prior preventive care.

Among factors affecting the rate of preventable emergency room (ER) visits:

• Income.
• Education.
• Employment.
• Health insurance coverage.
• Transportation access.
• Internet access.

Using emergency rooms for preventable care may generate excess costs for taxpayers, increase provider burden, and reduce the quality of patient care.

Emergency department visits (both preventable and non-preventable) cost $76.3 billion in the United States in 2017, according to a study conducted by the U.S. Agency for Healthcare Research and Quality.

It is hard to quantify the savings but according to another national study published in Health Affairs, diverting preventable visits into other, more appropriate forms of care (i.e., urgent care clinics or retail clinics) may save an estimated $4.4 billion annually.

A Ground-Breaking Partnership

Despite the potential for savings and improvements in quality of care, there has not been much research evaluating the individual-level characteristics associated with preventable emergency department use due to data limitations.

With this study, researchers were able to link emergency department visits to socio-economic characteristics from the American Community Survey (ACS) due to a unique partnership between the Census Bureau and the Utah Department of Health (UDOH).

Using linked records, the researchers assessed patterns in preventable visits to emergency departments across Utah hospitals from 2013-2017. The linked data were then used to examine the social, demographic and economic factors that contributed to the rate of these visits.

Income and Education

There was a clear correlation between income level and the frequency of preventable emergency care visits.

Individuals in lower-income households, on average, visited emergency rooms for preventable reasons roughly 2.5 times as often as those with higher incomes (Figure 1).

According to the study, individuals with lower educational attainment made more preventable emergency care visits than their more educated counterparts (Figure 2), likely because educational attainment is often linked with income and other socio-economic characteristics.

Individuals with less than a high school diploma made about three times as many preventable emergency care visits as those with a bachelor’s or higher degree.

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