Not surprisingly, reliance on emergency room care is not symmetric among demographic groups, and understanding the groups of individuals most likely to rely on emergency care can help in determining the most effective policy interventions to deliver affordable medical services potentially outside the constraints of typical business hours when one may be expected to be at work. The FAIR Health Survey revealed that the age group most likely to rely on emergency care is 18-34 year-olds (followed by those who are 65+), and education level most likely to rely on this is "high school graduate or less," the income level most likely to rely on this is "less than $35,000," and the racial group most likely to rely on this is Latinos (followed by blacks) (source: FAIR Health Survey).
These demographics should not surprise, given that those who can take off two hours from work to go to the doctor are more likely to have some measure of flexibility in their job, and those who would take off that time to go to the doctor for an outpatient visit may be more forward-thinking, or otherwise more health-conscious with respect to managing one's medical conditions. In contrast, those relying on emergency care, despite emergency care costing far more money, tend to be in poorer health (e.g., because they have waited until a crisis level as opposed to managing on an outpatient basis their conditions) and may have been unable to take time off of work to go to the doctor during business hours (which can be correlated with a lower income and associated health problems).
Knowing the age and racial groups most likely (relative to the overall population) to rely on emergency care can help us to target solutions toward delivering needed care without further contributing to the burdens of hospitals' emergency rooms. Part of this may entail determining the optimal location for urgent care facilities that operate during longer hours than many doctors' offices but which involve far fewer costs than do ERs (the typical cost of an urgent care visit is $127, compared with over $1,400 for an ER visit), thus concentrating care in the communities where it will be most utilized (e.g., communities with many young families or seniors, Latino communities, black communities). Another part of this may, however, be informational if people are a) unaware of where the local urgent care clinics are, or b) are unaware of the cost differential with respect to obtaining care in different centers under their insurance plans.
A different FAIR Health Survey revealed that people of different demographics factor in different costs with respect to their selection of health plans. I wrote recently on the rising out-of-pocket costs that patients have been facing in obtaining care in recent years, a trend that has contributed to discourse surrounding underinsurance under the ACA. Among the issues I addressed was the troubling fact that many do not appear to have a clear understanding of the costs associated with their medical plans.
Here, survey respondents were asked the following question: "Which one of the following is your most important consideration when enrolling in a health insurance plan? " Overall, 23% of respondents said that the monthly premium cost was the most important; 23% said out-of-pocket costs; 26% said the primary care physician accepting the plan; 10% said the deductible; and 6% said the number of doctors in the network. However, there is variation across age groups. Those in the 18-34 and 35-44 age groups valued premium cost the most (28%), suggesting that they are more focused on the present (definite) costs as opposed to the longer-term (potential) costs, despite the fact that those plans with higher premiums often are accompanied by lower copayments and lower coinsurance. And while 12% of 18-34 year-olds said that the deductible was the most important (slightly higher than the sample-wide rate of 10%), in general there is an inverse relationship between premiums and deductibles.
The notion that those of different stages of life will discount utility differently is hardly surprising, but the fact that younger people both value lower premiums and are most likely to rely on emergency care is an important and troubling from an economic standpoint as we examine rising out-of-pocket costs and underinsurance. This should factor in to how we expect younger people to purchase insurance, and how we might be able to counsel people to better obtain plans that fit their actual usage and to obtain care that better minimizes costs than does reliance on the notoriously expensive emergency care.