Emergency Departments:

Unevenly Affected by Growth and Change in Patient Use

HRD-93-4: Published: Jan 4, 1993. Publicly Released: Jan 14, 1993.

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Pursuant to a congressional request, GAO provided information about conditions that affected access to and use of hospital emergency departments (ED), focusing on: (1) changes in patients' use of ED; (2) the different sources of payments for ED services; and (3) ED timeliness in providing patient care.

GAO found that: (1) ED visits have increased nationwide by more than 19 percent between 1985 and 1990, while total hospital admissions decreased about 7 percent; (2) hospitals most frequently attributed increased ED use to such factors as the increase in persons without health insurance, a rise in the number of elderly using ED services, an increase in more serious illnesses, and illnesses and injuries related to AIDS, violence, and alcohol and drug use; (3) 43 percent of ED patients had illnesses or injuries that could have been treated in a less expensive setting, if available, but most patients went to ED even when there were alternative sources of nonurgent care; (4) access barriers to less expensive care included the lack of a primary care provider, lack of insurance, and provider unwillingness to treat Medicaid enrollees; (5) hospitals reported large increases in Medicare, Medicaid, and uninsured patient use of ED; (6) while most ED patients received timely physician examinations, those with less serious conditions waited longer than patients with life- or limb-threatening conditions; and (7) urban area hospitals experienced more ED delays than less urban hospitals, and those and those hospitals more frequently reported such contributing factors as AIDS, alcohol or drug use, violence, uninsured patients, and nursing staff shortages.

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