One of the things universal health care was designed to address was the use of the Emergency Room for routine medical care by uninsured individuals. It was hoped that if a person could call a clinic and make an appointment for an office visit and have insurance cover a significant portion of the cost, the trip to the emergency room would be avoided. Additionally, it was thought that, even if an emergency room visit could not be avoided, return visits to the ED would be limited because follow up concerns would be addressed by a primary care physician instead of making another trip to the hospital. Sadly, this has not been the case.

According to a recent article in the Annals of Emergency Medicine, there has not been a substantial decrease in the number of return visits to the Emergency Department. It would appear that at least some of the time, the return to the hospital is due to the inadequacies of the primary care system.

Changes in delivery such as referral of patients to the ED from outpatient care offices by nonmedical personnel, the decreased availability of telephone advice, group practice models limiting patient access to providers who know them, the absence of home visits for patients with mobility problems, and fee-for-service models that provide incentive for the volume of care are all likely contributors to the divide between patients and providers.

Kristin L. Rising, MD, MS, Kevin A. Padrez, BA, Meghan O’Brien, MD, MBE, Judd E. Hollander, MD, Brendan G. Carr, MD, MA, Judy A. Shea, PhD, “Return Visits to the Emergency Dept: The Patient Perspective,” ANNALS OF EMERGENCY MED. at 9 (2014). Based on their study following 60 patients discharged from an Emergency Room, the authors found that many returned to the ER because of the convenience (no waiting for an appointment and no having to take time off from work for daytime appointments). Others seemed to feel that they did not receive an adequate evaluation. To the extent this was derived from fewer tests being ordered and performed during the first visit, this would seem to indicate that limits on what is “unnecessary” is actually contributing to increases in costs by the patient’s perception that something critical may have been overlooked.

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