Academic journal article International Public Health Journal

Impact of Emergency Referrals to Primary Care on Health Care Use and Costs

Academic journal article International Public Health Journal

Impact of Emergency Referrals to Primary Care on Health Care Use and Costs

Article excerpt


Health care spending and outcomes in the United States are considerably different from other countries with similar wealth. In 2012, the United States (US) had the highest health care expenditures of the 193 World Health Organization member nations (1) and notably inferior health outcomes than countries with comparable wealth. Outside of the US, the most expensive system of health care costs only about twothirds as much as in the US (2), while, of the countries with similar resources, the US ranks last in mortality rates from preventable deaths (3, 4).

The high expense and poor outcomes in the US health care system bring into question whether the government is responsible for providing health care to its citizens. The issues of the government's role in health care have been debated recently, as the Obama Administration is working to address the health care problems in the US through new and controversial legislation in the Affordable Care Act.

One of these problems the Obama Administration is aiming to address is the lack of health insurance. The percentage of uninsured individuals living in the US has grown considerably in recent years, with rates increasing at double the growth of the population between 1980 and 2010 (5-8).

In addition to the high rates of the uninsured in the US, there are increasing percentages of the population using services of hospital emergency departments (9). The Emergency Medical Treatment and Labor Act (EMTALA) was enacted in 1986 by the US Congress, and mandates hospitals evaluate and treat emergency patients regardless of their ability to pay (10). Many studies suggest this may be a major contributing factor in the increase in emergency department utilization (11-13).

Issues surrounding emergency room (ER) crowding, use for non-urgent reasons, and frequent use are found in the literature to be contributing to health care expenses and problems in the health care system (14-16). Characteristics of frequent emergency department users have been identified, but there is still controversy surrounding whether these patients are more likely to be uninsured or simply underutilizing primary care (PC) services (17).

The high percentages of uninsured and increased use of emergency departments are problems with serious consequences, including increasing rates of uncompensated care. In 2004, hospitals in the US provided uncompensated medical care valued between $25.6 and $26.9 billion (18,19). In 2008 that number grew to an estimated $35 billion for hospitals, and $54.3 to $57.4 billion for all health care settings (20, 21). Emergency departments have decreased viability and the quality of emergency services is suffering due to these unpaid medical expenses (22).

This problem is putting individuals without insurance at increased medical risk. With limited and sometimes no other access to medical care outside of emergency department settings, the quality of those services and maintaining viability of hospitals is crucial to their health.

Social workers often work with individuals facing disadvantages or lacking personal resources, including people without health insurance, and this is directly affecting some of the individuals social workers help. As social workers intend to assist clients from a holistic perspective (23), helping them find appropriate, if not affordable, medical care is important, regardless of the context in which the social work interventions occur.

The role social work serves in hospital settings specifically is affected by cost factors (24). Costbenefit ratios are important to social work programs within hospitals, and have been calculated as these programs develop and evaluate services (24). As Kadushin and Kulys (25) predicted, the challenge for hospitals is to incorporate cost containment with the humanitarian objectives of providing medical services to individuals.

The social work profession emphasizes promoting equality, including equality in health (23). …

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