Emergency Room Use Varies by Income, Education and Race

Encouraging alternatives to an ER for nonemergencies can lower costs

By Stephen Miller, CEBS May 4, 2015

Employees’ likelihood of using the emergency room (ER) for nonemergency care varies significantly along generational and socioeconomic lines as well as by race, according to the results of a recent FAIR Health survey.

These disparities come at a time when there is a national spotlight on reducing health care costs. Workers are facing increased out-of-pocket expenses as employers look for ways to control health care premiums with high-deductible plans.

Visiting the ER for nonemergency care can be substantially more expensive than accessing care in other places, such as a physician’s office or an urgent care center, significantly raising individual out-of-pocket and overall health care costs. In addition, nonemergency care at the ER can often result in long wait times as true emergency care is prioritized.

Targeting education and communications to employees who are most likely to rely on the ER for nonemergency care, and helping these workers to find and use in-network primary care physicians and, when appropriate, local urgent care centers, can reap substantial savings for both employees and health plan sponsors.

ER Visits Continue to Climb

Emergency visits are continuing to rise across the U.S., according to a March 2015 survey of 2,099 emergency room doctors by the American College of Emergency Physicians.

Three-quarters of emergency physicians reported that emergency visits are going up—a significant increase from just one year earlier when less than half reported increases.

The survey findings, released in May 2015, revealed that:

Most ER doctors reported little or no reductions in the volume of emergency visits due to the availability of urgent care centers, retail clinics and telephone triage lines.

More than one-quarter (28 percent) reported significant increases in emergency patients while 47 percent saw small increases since the Affordable Care Act’s requirement to have health insurance took effect.

Most said the severity of illness or injury among emergency patients had either increased (44 percent) or remained the same (42 percent).



Care Choices: Demographic Differences

Respondents to the FAIR Health survey consisted of 1,011 adults in the U.S. who were polled March 5-8, 2015.

Among the findings: While all age groups are most likely to visit a primary care facility in a nonemergency situation, employees age 45 and older are more likely than younger adults to rely on primary care, whereas Millennials (ages 18-34) and younger Generation X workers (ages 35-44) are significantly more likely than their older counterparts to visit an urgent care center.

Question: In the event that you require treatment for a non-emergency or non-life-threatening situation, where would you most likely go for care?

Age

Emergency Room

Primary

Care

Urgent

Care

Walk-in Clinic at a Pharmacy or Retail Center

18-34

25%

43%

21%

7%

35-44

21%

54%

19%

3%

45-54

19%

64%

8%

5%

55-64

16%

62%

13%

7%

65+

22%

59%

9%

4%

Total Population

21%

55%

15%

5%

Source: FAIR Health.



People without college educations and with lower incomes were more likely to rely on the ER for nonemergency care than those with higher incomes or some higher education.

Education

Emergency Room

Primary

Care

Urgent

Care

Walk-in Clinic at a Pharmacy or Retail Center

High school graduate or less

31%

48%

14%

4%

Some college

19%

59%

14%

5%

College graduate

10%

63%

17%

7%

Total Population

21%

55%

15%

5%

Source: FAIR Health.



Household Income

Emergency

Room

Primary

Care

Urgent

Care

Walk-in Clinic at a Pharmacy or Retail Center

Less than 35K

32%

44%

16%

5%

35-49.9K

21%

61%

11%

6%

50-74.9K

15%

62%

13%

6%

75-99.9K

8%

76%

11%

5%

100K or more

5%

70%

18%

3%

Total Population

21%

55%

15%

5%

Source: FAIR Health.



Latinos were nearly twice as likely as the general population to go to the ER for nonemergency care (39 percent vs. 21 percent), the survey found, and a third of black respondents said they would rely on the ER in the event of nonemergency care.

Race/Ethnicity

Emergency Room

Primary Care

Urgent

Care

Walk-in Clinic at a Pharmacy or Retail Center

Black (non-Latino)

33%

43%

16%

6%

Latino

39%

35%

16%

8%

White (non-Latino)

16%

63%

14%

4%

Total Population

21%

55%

15%

5%

Source: FAIR Health.



“Helping underserved communities build solid health care literacy can potentially help to lower costs and remove some of the barriers to accessing care,” said Robin Gelburd, president of FAIRHealth, a nonprofit provider of consumer health care literacy and cost estimation tools in English and Spanish. “Consumers who understand how the health care system works are empowered to make informed choices about the appropriate location of service for routine, urgent and emergency care,” she told SHRM Online.

Message to Employees: The ER Is for Emergencies

The average cost of a visit to an urgent care facility is $127 vs. the average cost of $1,449 to visit a hospital ER. Moreover, ER visits average over four hours due to long waits, according to health insurer Cigna’s online brochure, If It’s Not an Emergency, Skip the Emergency Room.

The brochure asks employees to consider the amount of time and money (not to mention the amount of frustration) they’ll save by skipping the ER, and explains that urgent care facilities can be used for a number of nonemergency ailments and injuries such as:

• Earaches and infections.
• Minor cuts, bumps, sprains and burns.
• Fever and flu symptoms.
• Allergic reactions.
• Cough, cold and sore throat.
• Animal bites.
• Mild asthma.
• Urinary tract infections.
• Headaches.
• Back and joint pain.

A companion Cigna brochure shows when to go to an ER, a doctor’s office, an urgent care facility and a convenience care clinic typically located in a pharmacy or retail store.

Employers should also consider whether they are making it difficult for employees to take time off from work when most primary care offices are open. If so, they may be encouraging workers to turn to ERs, which operate around the clock.



Stephen Miller, CEBS, is an online editor/manager for SHRM. Follow him on Twitter @SHRMsmiller.

Quick Links:

Compensation & Benefits e-Newsletter:

To subscribe to SHRM's Compensation & Benefits

e-newsletter, click below.

Sign Up Now

SEMINARS

HR Education in a City Near You

Find a Seminar

Job Finder

Find an HR Job Near You

SPONSOR OFFERS

Find the Right Vendor for Your HR Needs

SHRM’s HR Vendor Directory contains over 3,200 companies

Search & Connect