Joy Lian

The rising cost of health care is a constant conversation in national rhetoric — according to the Centers for Disease Control and Prevention, the average American spent nearly $10,000 on health care in 2015.

Earlier this month, a Yale-directed study published in HealthAffairs explored how patients are seeking health care. The study was a collaborative effort involving researchers from the Yale School of Medicine, Northwestern University’s School of Medicine and the Brigham and Women’s Hospital located in Boston.

Arjun Venkatesh, emergency medicine professor at the School of Medicine and one of the head authors of the study, said that the paper focused on the treatment of what he calls “acute unscheduled care needs,” or unexpected ailments like a broken ankle or chest pain. According to the study, acute care needs differ from those that arise from preexisting conditions like diabetes, where a patient can anticipate their doctor visits.

The study found that the perception that emergency room visits are out-of-control is overblown.

“Despite what you hear from people that emergency department visits are rising fast, we found that they’ve been pretty flat and on a minimal increase when you take into account the growth of the population,” Venkatesh said.

Generally, researchers noticed a downward trend in visits to primary care doctors to treat acute needs. From the years 2002–2015, the rate went down nearly 33 percent. In contrast, visits to emergency departments only increased 12 percent.

What caused this shift? Venkatesh described many possible reasons. For one, he said, primary care is not set up like it used to be. Another potential explanation is the rise of alternatives like telemedicine, Minute-Clinics and Urgent Care. And a final possibility, according to Venkatesh, is the constraint that current primary care doctors have on resources.

“It used to be that if you called your primary care doctor’s office a decade ago, you could come in and see someone the same day. You can’t do that anymore — most primary care practices are so booked up that they cannot provide services for an acute care need, they say ‘go to the ER,’” Venkatesh said.

The study found that this trend is not just true for the broader American population, but is also true for more vulnerable populations such as Medicaid beneficiaries and adults over the age of 65.

Moving forward, the leaders of the study hope to integrate their findings to improve access to health care.

Primary author of the study Andrew Chou tweeted that “Acute care is more spread out across various venues than ever and is likely to continue. Therefore, some form of integration is desperately needed.”

Jessica Pevner | jessica.pevner@yale.edu