Decreasing Emergency Department Use Is a Complex Conundrum

* Abbreviations: ACA — : Patient Protection and Affordable Care Act ED — : emergency department Emergency department (ED) demand often exceeds capacity, and many, including those who provide care in EDs, believe that some ED patients should be cared for in less costly non-ED settings. One common proposed explanation for nonemergent ED use is the lack of access to care, in part due to inadequate insurance coverage.1 Although some policy makers have suggested that expanding health care coverage will improve access, and thereby decrease ED use, others contend that there could at least be a transient increase in ED use by those who have historically deferred care.2 There is also an assumption that having insurance equals access to primary care; however, that is not always the case. In adults, the effect of increased insurance coverage on ED use has varied, with some efforts resulting in decreases, whereas others result in increases.2 In their article “Trends in Pediatric Emergency Department Use After the Affordable Care Act,” Lee and Monuteaux3 used … Address correspondence to Rustin B. Morse, MD, MMM, Children’s Health, Children’s Medical Center Dallas, 1935 Medical District Dr, Dallas, TX 75235. E-mail: rustin.morse{at}childrens.com