Measuring Emergency Department Medical Care Spending in the US by Health Condition, Age, Sex, and Payer, 2006-2015

Abstract

The emergency department (ED) plays a critical role in the US health care system, yet estimates surrounding ED health care spending are limited, and generally are unable to capture ED spending for patients who are ultimately admitted to the inpatient setting. We leverage the Nationwide Emergency Department Sample to disaggregate bundled ED and inpatient spending, and harmonize that data with existing methods measuring US health care spending to generate ED health care spending estimates, broken down by health condition, age and sex demographic group, and payer from 2006 to 2015. Health care spending in the ED, including care for both “treat and release” ED care as well as ED care resulting in admission to the inpatient setting, increased from $68 billion in 2006 to $132 billion in 2015. Of the $132 billion of ED spending in 2015, $67 billion (UI, $66-$67.9) or 50.7% (UI, 50%-51.5%) of total spending was spent by public insurance, $59.9 billion (UI, $58.9-$60.9) or 45.4% (UI, 44.6%-46.1%) was spent by private insurance, and $5.1 billion (UI, $5-$5.3) or 3.9% (UI, 3.8%-4%) was spent out-of-pocket. In 2015, the health conditions with the greatest amount of spending in the ED were falls ($11.3 billion [UI, $10.2-$12.5]), urinary disease and male infertility ($8.8 billion [UI, $8.0-$9.6]), and exposure to mechanical forces ($8.8 billion [UI, $7.7-$10.2]). This study generates estimates for both total ED health spending and ED spending patterns by specific health condition, demographic information, and by payer, and these estimates provide valuable descriptive evidence on which future health policy discussions and research can be based.