Health Policy Journal Club, Health Policy, Health Equity, Health Care Administration, Social EM, COVID-19, Administration & Operations

A New Pandemic

Decreases in ED Visits During Early Pandemic Seen Across the Board

The COVID-19 pandemic affected every aspect of life and caused a significant strain on our health care system. However, during the pandemic's initial days, emergency departments (EDs) across the country saw a decrease in patient visits as high of 40-60% at the pandemic start. Who were these missing patients? Were we missing lower acuity patients while still treating the same amount of heart attacks and strokes, or were specific subpopulations disproportionately affected?

These questions were addressed in a recent study that looked at characteristics of patients presenting before the pandemic compared to the months after its start in a large metropolitan health care system with 13 EDs. The authors found non-emergent visits decreased by 52%, while emergent/non-preventable visits decreased by 40% - not a statistically significant difference. There were decreases in ED visits by Medicare, Medicaid, and privately insured patients; however, the only statistically significant difference was noted between patients with Medicare (31% decrease) and those with private insurance (46% decrease). Overall, there were no significant differences in the decrease in ED visits by acuity, age, sex, race, or co-morbidities.

The effects of COVID-19 on the health care system continue to evolve, with many now actually experiencing higher ED volumes, likely due to many of those who delayed care during the pandemic. Post-pandemic, patients now have increasingly frequent and complex medical needs, adding a new strain on our health care system. This study showed that these delays in accessing care occurred across the population – rather than only in small sectors, indicated that large scale changes must be made across the board to address patient needs. Policymakers and healthcare administrators should start planning now to ensure that in future pandemics, regular and emergent health care services remain safe, affordable and accessible to prevent large swings in health care utilization.


ARTICLE: Yu J, Hammond G, Waken RJ, Fox D, Joynt Maddox KE. Changes in Non-COVID-19 Emergency Department Visits by Acuity and Insurance Status During the COVID-19 PandemicHealth Aff (Millwood). 2021; 40(9):1465-1472.

Prior studies suggest that the COVID-19 pandemic was associated with decreases in emergency department (ED) volumes, but it is not known whether these decreases varied by visit acuity or by demographic and socioeconomic risk factors. In this study of more than 1 million non-COVID-19 visits to 13 EDs in a large St. Louis, Missouri, health system, we observed an overall 35% decline in ED visits. The decrease in medical and surgical visits ranged from 40% to 52% across acuity levels, with no statistically significant differences between higher- and lower-acuity visits after correction for multiple comparisons. Mental health visits saw a smaller decrease (-32%), and there was no decrease for visits due to substance use. Medicare patients had the smallest decrease in visits (-31%) of the insurance groups; privately insured (-46%) and Medicaid (-44%) patients saw larger drops. There were no observable differences in ED visit decreases by race. These findings can help inform interventions to ensure that people requiring timely ED care continue to seek it and to improve access to lower-risk alternative settings of care where appropriate.

EMRA + PolicyRx Health Policy Journal Club: A collaboration between Policy Prescriptions and EMRA

As emergency physicians, we care for all members of society, and as such have a unique vantage point on the state of health care. What we find frustrating in our EDs - such as inadequate social services, the dearth of primary care physicians, and the lack of mental health services - are universal problems. As EM residents and fellows,  we learn the management of myocardial infarctions and traumas, and how to intubate, but we are not taught how health policy affects all aspects of our experience in the ED. Furthermore, given our unique position in the health care system, we have an incredible opportunity to advocate for our patients, for society, and for physicians. Yet, with so many competing interests vying for our conference education time, advocacy is often not included in the curricula. This is the gap this initiative aims to fill.  Each month, you will see a review of a new health policy article and how it is applicable to emergency physicians.  

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