Summary: Patient caseloads in emergency rooms nationwide soared between 1985 and 1990. Nearly 85 percent of hospitals reported an upsurge in emergency room use by patients with nonurgent conditions--more than 40 percent of all emergency room patients in 1990. The largest rise in emergency room visits was by Medicaid patients, who traditionally have high rates of emergency room use for nonurgent conditions. Nonurgent use by uninsured patients also contributed to the emergency room caseload growth during the six-year period. Growth in emergency room use was most pronounced among patients whose medical care is often not fully reimbursed, such as Medicaid, Medicare, and uninsured patients. At the same time, however, little growth occurred in emergency room use by patients with private insurance. This disproportionate growth may make it harder for hospitals to absorb or offset losses due to unreimbursed emergency room care. GAO did observe some appreciable variations in emergency room conditions by community size. For example, emergency rooms in urban areas were most likely to have patients waiting a long time for treatment. Furthermore, these emergency rooms were the most likely to have a larger share of uninsured patients and increased visits due to AIDS, drug abuse, and violence.
