CONTRARY TO POPULAR BELIEF, ER VISIT MAY BE CHEAPER.

Byline: Jason Kahn Medical Tribune News Service

Many people who seek treatment in hospital emergency rooms do so for relatively minor medical reasons, resulting in unnecessary, costly visits, according to one widely held view.

But two new studies show that the actual costs incurred by ER visits for nonserious problems are low, and that using a co-payment system to discourage unnecessary visits actually turns away patients who should be seen in the ER.

A review of six community hospitals in Michigan found that the average cost of treating an additional nonurgent patient in the ER was $24, "far less than generally assumed," lead researcher Dr. Robert Williams  of the University of Michigan School of Public Health in Ann Arbor reported in a recent issue of the New England Journal of Medicine.

In another study of ER use at a large HMO in Northern California, investigators found that requiring a co-payment of $25 to $35 for each ER visit cut down on patient care for nonemergency reasons. But visits for conditions that were deemed "often an emergency" also decreased by roughly 14 percent over a yearlong period, Dr. Joe Selby of the Kaiser Permanente Medical Care Program in Oakland observed in the same issue of the journal.

The results of these studies appear to dispel the notion that nonacute care in the ER is needlessly expensive. Nevertheless, the costs of nonurgent visits to the emergency room in 1993 were approximately $5 billion to $7 billion, according to the journal Health Affairs.

The decrease in visits to the ER for serious reasons, however, "is troubling," said Dr. Robert Steinbrook, deputy editor of the journal, who wrote an editorial accompanying the studies. Many of these patients had diagnoses that included head trauma, pregnancy complications or chest pain. "By any standard, a substantial proportion of patients with these diagnoses should be evaluated in the emergency department," he said.

In the Michigan study, Williams determined the average costs and charges for ER use over a three-year period. As the urgency of the visits increased, so did the cost of treating additional patients. For instance, an additional semi-urgent patient cost $67, while an additional urgent case cost $148, according to the study.

Because the average cost of a nonurgent visit to the ER is so low, the potential savings from diverting such patients to their doctors' offices may be "much less than is widely believed," Williams said.

"This is one of many widespread financial myths about health care," commented Alan Sager, an instructor of health-care finance at the Boston University School of Public Health. "The real cost of nonurgent care is very low, because the patient waits until someone is free to see them. The ER staff is there no matter what. It's the urgent emergency cases that are very expensive."

In the California study, researchers assessed ER visits made by 30,000 patients before and after instituting the co-payment system, comparing them with 98,000 patients who were unaffected by the co-payments. Overall, ER visits declined by 15 percent in those affected by the co-payments.

But "using a monetary charge is a deterrent to the poor," Sager said.

"We need clinical triage, not financial triage."