California Counts population trends and profiles Emergency Department Care in California Who

Hospital emergency departments are a critical part of the U.S. health care system, providing the only guaranteed source of health care for the uninsured and offering around-the-clock health care access to everyone. In 2006, more than ten million visits were made to California hospital emergency departments. Heavy use of emergency departments, including use by patients seeking treatment for nonurgent conditions, coupled with hospital and emergency department closures, have contributed to overcrowded conditions in many emergency departments. Longer waiting times for patients and more ambulance diversions to surrounding hospitals have been the result, leading state health officials and local planners to become concerned about the sustainability of the current system. In this issue of California Counts, to provide a basis for assessing the current stability of the system, we describe trends in emergency department capacity and use and create detailed profiles of emergency department visits. We look in particular at overcrowding and the use of emergency departments for nonurgent conditions. Although the number of operating emergency departments in the state declined over the past decade, we find that in aggregate, emergency departments appeared to keep pace with patient visits by expanding the number of treatment stations or beds. However, many still struggle with overcrowded conditions, particularly public hospitals and those in poor areas with large numbers of MediCal beneficiaries. We find that Los Angeles County and the Emergency Department Care in California 2 Central Valley are home to some of the most crowded emergency departments in the state. In addition, we describe patterns of use among different groups by examining all emergency department visits in California hospitals in 2005. We find that MediCal and Medicare patients have the highest visit rates in the state and that the high volume of emergency department visits is not driven by uninsured Californians. MediCal patients are more likely than the uninsured or the privately insured to use an emergency department for nonurgent or avoidable conditions. So are parents of infants younger than one year old, who seek treatment for common childhood illnesses that likely could be treated in other outpatient settings. We also find high emergency department use and subsequent hospital admission among older Medicare patients—not surprising given the frailer health status of the elderly. Furthermore, we find that immigrant Hispanics and Asians use emergency departments less than U.S.-born whites, and that noncitizen immigrants in particular are among the least likely to report a recent …