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Press Release · August 19, 2008

Medi-Cal Patients Are Heaviest Users of Emergency Departments — Majority of Visits May Be Avoidable

There’s Gridlock in the ER – Particularly in L.A., Central Valley – But Not Because of Immigrants, the Uninsured

SAN FRANCISCO, California, August 19, 2008 — Medi-Cal patients are more likely than uninsured or privately insured Californians to visit hospital emergency departments for conditions that could be treated in a clinic or doctor’s office. Overall, four in 10 visits to the state’s hospital emergency departments are potentially avoidable. A report released today by the Public Policy Institute of California (PPIC) also finds that immigrants are not crowding the state’s emergency rooms – in fact, foreign-born Californians who are not U.S. citizens are among the least likely to seek treatment in the ER.

At a time when state and national policymakers are focusing on health care, the PPIC study focuses on a key part of the system. Many California hospitals have closed in the last decade, leaving the remaining emergency departments to treat more patients. The consequences can be life threatening. Emergency departments are the health care safety net for all Californians: They are open 24 hours a day, they are the only guaranteed source of care for the uninsured, and they play a critical role in disaster response.

Emergency departments throughout the state, particularly in Los Angeles County and the Central Valley, struggle with crowded conditions. Large public hospitals and those in poor communities that serve large Medi-Cal populations are most strained.

“What we see in many emergency rooms are symptoms of problems that afflict the health care system as a whole and affect everyone,” says Shannon McConville, PPIC research associate, who co-authored the report with PPIC research fellow Helen Lee. “If we want to reduce unnecessary use of emergency departments, we need to reassess patients’ ability to find primary care providers and be treated in a timely fashion.”

“Only half of California doctors participate in Medi-Cal, which means access is more difficult and an emergency room visit is more likely for these patients.”

The report, Emergency Department Care in California: Who Uses It and Why?, also finds:

  • The uninsured are nearly twice as likely to visit the emergency department as the privately insured but far less likely than Medi-Cal or Medicare patients. This is likely a reflection of the insurance coverage of different age groups: Medi-Cal covers many children, while Medicare patients tend to be older and in frailer health.
  • Children under 18 account for a quarter of emergency department visits. Children covered by Medi-Cal make more potentially avoidable emergency room visits than privately insured and uninsured children.
  • Infants have the highest proportion – nearly seven in 10 – of potentially avoidable emergency department visits. Babies less than a year old with common childhood ailments, such as ear infections or fevers, are frequent visitors to the emergency room, regardless of the family’s insurance status.
  • Medicare patients are frequent emergency room visitors, but fewer than three in 10 visits by patients over 65 were considered avoidable. Forty percent of the patients in this age group are admitted to the hospital for further treatment.
  • The three counties with the highest per-capita emergency department visit rate are in the Central Valley: Stanislaus, Fresno, and San Joaquin. This is a region with some of the highest poverty levels in the state, fewer physicians, and large numbers of uninsured residents.

The PPIC study, which was done with funding from the California Program on Access to Care, suggests that expanding access to high-quality care outside the hospital could reduce avoidable emergency room visits. Parents who can go to an urgent care center in the early evening – the peak time children go to the ER – or on weekends may be less likely to go to the hospital. Broadening the network of community health care centers and expanding the supply of primary care physicians in underserved areas may also improve preventive health care for the uninsured and publicly insured.


The Public Policy Institute of California is a private, nonprofit organization dedicated to informing and improving public policy in California through independent, objective, nonpartisan research on major economic, social, and political issues. The institute was established in 1994 with an endowment from William R. Hewlett. PPIC does not take or support positions on any ballot measure or on any local, state, or federal legislation, nor does it endorse, support, or oppose any political parties or candidates for public office.