Many poor people prefer emergency rooms to primary care doctors for good reasons, according to a study by The Perelman School of Medicine at the University of Pennsylvania. Some policy makers had assumed poor people’s high ER use is an abuse of the system, but the choice is a rational one, according to the new study.
Researchers interviewed 64 patients with low socioeconomic status who preferred to receive medical attention from hospitals. In a press release, David Grande, MD, MPA, assistant professor of Medicine at Penn Medicine and senior author, said the study debunked the idea that lower socioeconomic status individuals need to learn to how to get medical care, or are abusing ER services. On the contrary, the individuals thoughtfully explained the ways the medical system incentivizes waiting until hospital care is needed.
“To generate system-wide savings, it’s important to make outpatient services more appealing to low-SES patients by addressing their concerns around cost, quality and accessibility,” said lead author Shreya Kangovi, MD in a statement. She is director of the Penn Center for Community Health Workers.
The Centers for Disease Control and Prevention reports a total of 129.8 million emergency room visits each year. Uninsured individuals have always been more frequent users of emergency services as primary care. People who have insurance are using them more, too.
People with insurance who choose to visit the emergency room over their primary care doctor feel that care and services received in hospitals is of better quality than they would get if they were to wait and see a primary care physician. “[My primary care physician] didn’t help me. I had to go to the emergency room just to get rid of this. She couldn’t do it,” one participant said, according to a press statement from Penn Medicine.
Complications arise when attempting to make an appointment with a primary care doctor. Busy phone lines, recordings that are hard to understand, and difficulty calling from the job during work hours make it harder for poor people to contact a doctor to begin with. Additionally, wait times to see a doctor for a minor illness, aches or pains can be two weeks. Transportation is often an issue-but the ER is a one-stop shop.
Visiting a primary care physician, and then a specialist for another appointment or a lab for more tests is not always cost effective, even with insurance. For poor people using Medicaid, outpatient care and ER care are similar in cost, according to the study, but in the ER there does not need to be a second visit to a specialist, more time off work for follow-up visits, or more expenses for transportation.
The study was published in the July Issue of Health Affairs.