Dispelling Myths About ED Use

Majority of Medicaid Visits Are for Urgent or More Serious Symptoms

Contrary to conventional wisdom that Medicaid patients often use hospital emergency departments (EDs) for routine care, the majority of ED visits by nonelderly Medicaid patients are for symptoms suggesting urgent or more serious medical problems, according to a national study released by the Center for Studying Health System Change.

This research brief, funded by the Robert Wood Johnson Foundation, looks at the two kinds of information from such visits that generally are used to explain ED use—patients’ symptoms as assessed by ED triage staff to determine how quickly patients need evaluation, and patients’ diagnoses after evaluation by a physician.

While nonelderly Medicaid patients do use EDs at higher rates than nonelderly privately insured patients, the percentage of those visits that were for nonurgent symptoms is not considerably higher than the rate for their privately insured counterparts. The authors found that about 10 percent of nonelderly Medicaid patient ED visits were for nonurgent symptoms, compared with about 7 percent of ED visits by privately insured nonelderly people in 2008. In contrast, slightly more than half of both Medicaid and private insurance visits were categorized as emergent—needing immediate—or urgent—attention within an hour.