Who Overuses Emergency Rooms?

The stereotype is that Emergency Rooms are overcrowded with Medicaid / low-income people misusing the service. Like any good stereotype, it’s partly true and partly false.  

If everyone used the ER at the same rate, each blue bar in the graph below would match its orange bar. Privately insured people make up 59% of the total population and use only 31% of the ER visits. (Health Care Utilization Project, 2024) (Bureau, 2020) That’s the true part – Medicaid members do use “more than their share” of ER visits.

And here’s the false part: on any given day, you would find 3 out of 10 ER patients were Medicaid . . . and 3 out of 10 patients were privately insured. By having more total visits, privately insured people actually crowd the ER more than Medicaid members.  

Simply by being different people – living in lower-resource neighborhoods, having lower-paying jobs, having more frequent and more severe illnesses – Medicaid members have different medical needs. These differences explain 44% of the gap between Medicaid and privately insured people’s use of emergency care. When you factor in the availability of primary care physicians, these traits explain more than half of the difference in ER use. (Kim H, 207)

Still, Medicaid members use emergency care more frequently. The question is why. One very nifty study grouped Medicaid members by their social determinants of health. It found that those who had higher social needs also had higher ER visits that might have been treated at a doctor’s office. (McCarthy ML, 2021) Makes sense that someone who has unstable housing, food insecurity, and an erratic work schedule would use more ER services than someone who owns their home, has a well-stocked fridge, and a dependable job.

The ER visits are the effect of complex social and health factors. Focusing on the ER visit as the problem is like painting a picture by watching the brush. You’ll get a blurry useless picture.

Works Cited

Bureau, U. C. (2020). Health Insurance Coverage in the United States: 2020.

Health Care Utilization Project. (2024). Retrieved from https://datatools.ahrq.gov/hcup-fast-stats/#downloads

Kim H, M. K. (207). Comparing Emergency Department Use Among Medicaid and Commercial Patients Using All-Payer All-Claims Data. Population Health Management, 271-277.

McCarthy ML, Z. Z. (2021). The Influence of Social Determinants of Health on Emergency Departments Visits in a Medicaid Sample. Ann Emerg Med, 511-522.