Comparison of Emergency Room Utilization for Non-Emergent Purposes Before and After the Implementation of the Affordable Care Act


  • James Hess, Ed.D. OSU Center for Health Sciences
  • Bavette Miller, Ph.D. OSU Center for Health Sciences
  • William Paiva, Ph.D., MBA OSU Center for Health Sciences
  • Jeffrey Stroup, PharmD, BCPS, FCCP OSU Center for Health Sciences
  • Elvena Fong, M.S., M.B.A.


Emergency room utilization, nonemergent utilization, ER utilization, Affordable Care Act


The implementation of the Patient Protection and Affordable Care Act (ACA) brought significant changes to the healthcare landscape. Many of the provisions of the ACA were intended to create greater access to healthcare services as well as to lower overall healthcare costs. One of the intentions of the ACA was to provide opportunities for patients to seek treatment at the appropriate level of care, i.e. primary care outpatient visits rather than emergency room (ER) utilization. The premise of this effort ostensibly was to lower healthcare costs by treating non-emergent illnesses at the lowest cost level. Additional provisions of the ACA such as mandated insurance coverage were intended to provide insurance coverage for patients to seek primary care services. Thus the cumulative impact of these provisions was predicted to increase access to primary care while simultaneously reducing non-emergent utilization of ER services. This study documents overall ER utilization as well as ER visits for non-emergent treatment before and after the implementation of the ACA. The analysis of the data revealed ER utilization increased in the five years after the ACA went into effect compared to the five-year period before the Act was implemented. In addition to the overall increase in ER visits, non-emergent visits also increased significantly during the same evaluation period. The study also revealed that Medicaid was the most common payer source for ER visits and unnecessary ER utilization rates were higher for rural hospitals than urban hospitals.


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