Too many people are still relying on emergency departments as their go-to place for health care, despite the Affordable Care Act.

According to a study published in JAMA Network Open found that even though more people are insured and uninsured ED visits dropped after the implementation of the ACA in 2014, ED visits overall are still on the rise. In fact, they rose by 2.3 million a year between 2006 and 2016, although the proportion of visits that were uninsured stayed relatively static from 2006 to 2013 and constituted 14 to 16 percent of visits. Uninsured visits, the report adds, made up 8 percent of all ED visits by 2016.

According to the study's author, Dr. Adam Singer, professor and vice chairman for research in the department of emergency medicine at Stony Brook University's Renaissance School of Medicine, the findings indicate that too many people are still depending on hospital EDs as their chief provider for health care—despite increased insurance coverage and other places to go for care, such as urgent care centers and retail health clinics.

“When one in 10 patients' ED visits and one in 20 hospital discharges are among patients with no insurance, it shows that there is still a lot of work that needs to be done to expand access to coverage,” Singer told Modern Healthcare.

Other studies have revealed similar results—that just having insurance isn't enough to keep people out of the emergency room. Although the ACA has resulted in fewer uninsured patients coming to the emergency room, people still turn to EDs rather than to alternate care providers—and raises the question of whether there are factors other than insurance coverage that are hindering efforts to encourage patients to turn to other providers.

Although hospitalizations have come down as people receive care from outpatient facilities, the fact that the same is not true for ED visits implies that the increase in ED utilization is less preventable than hospitalizations. In addition, hospitals are increasingly classifying patients who come to the ED with observation status rather than admitting them.

“I think at the end of the day my question would be, do you have access to care because of insurance, or are there still financial impediments to that process,” said Dr. Rade Vukmir, spokesman for the American College of Emergency Physicians. “If you look around you'll find that there may be.”

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Emergency departments still see high utilization, despite ACA

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