Cost, Quality, Accessibility Spur Poor to Choose ER Care

Current U.S. health care system makes it easier to go to hospital than visit doctor's office, findings show

By Robert Preidt

Monday, July 8, 2013

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MONDAY, July 8 (HealthDay News) -- Poorer Americans are more likely to seek treatment at hospitals than from primary care doctors because hospitals are less costly, more convenient and provide better quality care, a new study indicates.
The findings are important in terms of efforts to lower health care costs by reducing avoidable hospitalizations, readmissions and emergency room visits, according to the University of Pennsylvania researchers.
The investigators noted that U.S. data consistently show that poor patients use less preventive care and are more likely to become acutely ill and require urgent hospital care, something that can't be explained solely by lack of insurance. This pattern of health care use costs $30.8 billion annually, and leads to poor health outcomes for these patients.
"Our findings suggest that efforts to reduce hospital readmissions solely by improving the quality of hospital care could backfire by making hospitals even more attractive for [poor] patients," study author Dr. Shreya Kangovi, director of the Penn Center for Community Health Workers, said in a university news release.
"To generate systemwide savings, it's important to make outpatient services more appealing to [poor] patients by addressing their concerns around cost, quality and accessibility. For instance, health systems might reduce barriers such as complicated referral systems that are often required for seeing specialists. These barriers may actually drive patients to the higher-cost, one-stop shop hospital setting," Kangovi explained.
The study included 40 poor patients in Philadelphia who were interviewed about why they decided to get treatment at the hospital/emergency department instead of from a primary care doctor.
The patients felt that hospitals were better able to diagnose and treat health problems. They also said that the emergency department provides a "one-stop shop" for health care services, has shorter wait times, and is easier to get to than a doctor's office.
The study also found that uninsured patients often can't afford the cost of regular visits to the doctor, leaving them no choice but to rely on hospital charity care when they become ill. Among Medicaid patients, costs were similar for emergency department and doctor office visits. However, the overall cost of seeing a primary doctor was higher due to the additional time and expense required for specialty visits or additional testing recommended by the doctor.
The study appears in the July issue of the journal Health Affairs.
"This study debunks the perception that [poor] individuals abuse the emergency room and need to be educated on its proper use," senior study author Dr. David Grande, an assistant professor of medicine, said in the news release. "To the contrary, these patients eloquently explained to us how we have built a health care system that incentivizes them to wait and get sick in order to get care that is more costly to society."

SOURCE: University of Pennsylvania School of Medicine, news release, July 8, 2013

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