Everyone seems to have a horror story about waiting for an ungodly length of time to be seen by a provider at the emergency room (ER). This is not surprising, considering each year the number of patients seen in the emergency room grows and the patient wait time to receive care increases. This is a symptom of a failure within our health-care system to provide sufficient alternatives to the ER.
Of all ER patients, 79.7 percent cited lack of access to another provider as a reason for their visit; 66 percent cited the severity of their medical condition. Expanding access to primary care has been discussed as a remedy, but will not solve the problem entirely.
A barrier to primary care use is an inability to make scheduled appointments because of a lack of reliable transportation or work schedule restrictions. If a patient works during the day, then the ER may be their only option for health care outside of work hours. Since over half of all ER visits occur outside normal clinic business hours (Monday-Friday 8 a.m. to 5 p.m.), it is not surprising that 48 percent of all ER patients cite their doctor’s office was closed as a reason to use the ER. These barriers to alternative health-care options lead patients to the ER when they could be treated appropriately elsewhere at a lower cost.
Urgent care could handle many conditions seen in ER
The three most common conditions seen in the ER are: sprains and strains, superficial injury/contusion, and abdominal pain, respectively. These three conditions accounted for over half of all ER visits in 2011 and in most cases could be treated in an urgent care facility.
Furthermore, only 14.2 percent of all ER patients had medical conditions in need of immediate emergency care. A large portion of ER patients could be treated just as effectively and at a lower cost at an urgent care facility.
Urgent care facilities can provide care for patients with health conditions that need “urgent” attention, but are not emergencies. These facilities do not require an appointment and are generally open later than primary care clinics and on the weekend.
Current urgent cares fall short of filling the void in Minnesota’s health care system. On average urgent care facilities are open daily from 7 a.m. to 9 p.m., leaving a large swath of time where the ER is the only health-care option available.
The cases considered most severe at admission to the ER are seen first. So patients who have less severe medical conditions are left waiting the longest for care. These patients would benefit the most from being seen in an urgent care.
Beyond the benefit of cost and time saving, increasing urgent care use allows more focused care in the ER for patients in true medical emergencies because of the reduction in total patients.
Subsidy needed for expansion
Minnesota needs to subsidize the expansion of urgent care accessibility and affordability across the state. To increase late night health-care options, state money should be used to expand operation hours to 24-hour availability. To increase affordability, MNsure should consider waiving co-pay requirements for appropriate use of urgent care visits as is done for ER and primary care visits.
Even with more urgent care availability, patients need to know these facilities are available. Currently, urgent cares are underutilized. Minnesotans need to be educated about when to use the urgent care rather than the ER.
Minnesota is a national leader in health care, but action needs to be taken to reform our emergency medicine system. The wait time to be seen by a medical provider in Minnesotan ERs is higher than the national average. Allocating state funds toward expanding urgent care availability and usage would be a wise investment for the state.
Caleb Hoover is a master’s student in the Health Services Research, Policy, and Administration program at the University of Minnesota- School of Public Health. He is also a research associate at Allina Health on its LifeCourse project.
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