More Californians Visiting ER For Chronic Medical Conditions

Traditionally people think of a hospital emergency room as a place to go for injuries: someone gets in a car accident, has a heart attack, or falls out of a tree and breaks his leg. But the ER also plays a large role in treating medical patients.

Millions of Californians visit emergency departments for help with non-injury related health problems -- and that number is rising, according to a study recently published in the April edition of Health Affairs.

The study, led by the University of California, San Francisco, shows the rate of emergency room visits for non-injury related problems rose 13.4 percent in the state, from 10.1 million visits in 2005 to 11.9 million visits in 2011. The largest increase in non-injury related ER visits were for gastrointestinal diseases, abdominal pain and nervous system disorders.

Renee Hsia is a professor of Emergency Medicine and Health Policy Studies at UCSF, and the lead author of the study. She says hospital admissions rates are a window into California's health care system.

"Maybe patients are coming to the emergency department because they are pressured for time because [primary care doctors] only have 15 minute appointments," Hsia says. "Or maybe because [primary care doctors] don’t have good access to imaging, or because there’s a changing culture in how people want to be treated: they don’t want to wait a few weeks to get a diagnosis, they want it now. There’s a whole host of possibilities about why these findings might be the case."

Hsia says another reason may be that patients are living longer because of advances in medicine -- and that means they're also living longer lives with more chronic diseases.

But it's not just seniors: people under 65 years old, including both insured and uninsured patients, are also increasingly visiting the emergency rooms for non-injuries too.

"I think there’s this common misperception that, ‘Oh the emergency department is overcrowded by all these uninsured people who are coming for care.' But actually their rate is lower than insured people."

The study also shows a big rise in ER visits for people with mental health disorders. Hsia, who is also an emergency physician at San Francisco General Hospital, says she sees this at SF General, and it's indicative of a statewide problem.

"It used to be if you had mental health conditions that required hospitalization it would be fairly easy to find a bed for you. But now since the funding for mental health beds has been decreasing we don't have the access to that. People come to the emergency department for treatment and we aren’t able to give them long term care. We may hold them in the ER for awhile, but then we have send them back to the street."

Hsia says California mandates that hospitals report every discharge, whether it’s in-patient or out-patient, so they were able to get statewide hospital data. This kind of data isn't available on a national level. But, Hsia says, since California represents 12 percent of the population, it’s likely that a lot of these findings apply in a national context.

"The study gives you kind of a bird’s eye view of what’s happening in the health care system overall. You can see if people are having changes in their ability to access parts of the health care system. Like if it’s too hard to get speciality care, or primary care, eventually they end up coming to the ER."