One reason sometimes given to expand health care coverage is that if someone has health insurance, then they are less likely to use the emergency room for treatment. One reason for this is that someone with health insurance will be more likely to use primary care and less likely to need emergency room treatment. It also makes sense that a person with insurance would get more preventative care and be less likely to need a trip to the emergency room.
On the face of it, reducing emergency room visits would be good. One reason is that emergency room care is expensive and reducing it would save money. Another reason is that the emergency room should be for emergencies—reducing the number of visits can help free up resources and reduce waiting times.
So, extending insurance coverage would reduce emergency room visits and this is good. However, extending insurance might increase emergency room visits. In one seemingly credible study, insurance coverage resulted in more emergency room visits.
One obvious explanation is that the insured would be more likely to use medical services for the same reason that insured motorists are more likely to use the service of mechanics: they are more likely to be able to afford to pay the bills.
On the face of it, this does not seem bad. After all, if people can afford to go to the emergency room because they have insurance, that is better than having people suffer because they lack the means to pay. However, what is most interesting about the study is that the expansion of Medicaid coverage increased emergency room visits for treatments more suitable for a primary care environment. The increase in emergency use was significant—about 40%. The study was large enough that this is statistically significant.
Because of this, it is worth considering the impact of expanding coverage on emergency rooms. Especially if it is argued that expanding coverage would reduce costs by reducing emergency room visits.
One possibility is that the results from the Medicaid study would hold true in general, so that expansions of health care coverage would result in more emergency room visits. If an expansion of coverage results in significant increase in emergency room visits, this would not help reduce health care costs if people go to the more expensive emergency room rather than seeking primary care.
But an insurance expansion might not cause significantly more non-necessary emergency room visits. One reason is that private insurance companies seem to try to deter emergency room visits by imposing higher payments for patients. In contrast, Medicaid did not impose this higher cost. Thus, those with private insurance would tend to have a financial incentive to avoid the emergency room while those on Medicaid would not, unless there was an increased cost for the Medicaid patient. While it does seem wrong to impose a penalty for going to the emergency room, one method to channel patients towards non-emergency room treatment is to impose a financial penalty for emergency room visit for services that can be provided by primary care facilities. One moral concern with imposing such penalties is that some forms of care are only available through emergency rooms. For example, when I had to get rabies shots in 2023, the only option was the emergency room. But it could be replied that such treatments are unusual, hence the penalty would not affect many people.
People might use emergency rooms instead of primary care because they do not know their options. If so, if more people were better educated about medical options, they would be more likely to choose options other than the emergency room when they did not need emergency room services. Given that the emergency room is stressful and involves a long wait (especially for non-emergencies) people would probably elect for primary care when they know they have that option. This is not to say education will be a cure-all, but it is likely to help reduce unnecessary emergency room visits. Which is certainly a worthwhile objective.