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Health Economics Article Critique

Erin A. Avery

School of Nursing, James Madison University

NSG 471: Leadership and Management in Health Care

Dr. Kile

February 24, 2024

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Health Economics Article Critique

Pickens, G., Smith, M., McDermott, K., Mummert, A., & Karaca, Z. (2022). Trends in treatment

costs of U.S. emergency department visits. American Journal of Emergency Medicine,

58, 89-94. https://pubmed.ncbi.nlm.nih.gov/35660368/

For this assignment, it was important for me to find an article related to health care

economics in the department of which I work. I have always thought that emergency department

(ED) bills were exceedingly costly, and this article confirms my belief, stating that one visit

typically runs $1082. The United States (US) healthcare spending is extensive and growing

rapidly, specifically in the ED. This article analyzes the growth rates in ED treatment costs.

Background

In the last several years, costs associated with ED services have risen faster than any

other area of healthcare. Accomplishing a study to determine where and how these costs have

increased could shed light on ways to reduce overall expenditures.

Purpose

Authors of this article identified previous studies that examined costs associated with ED

visits and expenses over time, but acknowledged the need for additional data analyzation. The

authors sought to collect data that specifically focused on variations in ED treatment costs over a

specified time span.

Methods

This observational study was retrospective that examined cost trends associated with ED

visits across hospitals in the US from 2012 to 2019. The authors collected annual data from the

Agency for Healthcare Research and Quality (AHRQ), Nationwide Emergency Department

Sample (NEDS), and the Healthcare Cost and Utilization Project (HCUP).
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Results

Costs associated with ED visits raised from $54 billion in 2012 to $88 billion over the

span of 7 years. An interesting statistic to keep in mind, the GDP rate only increased 1.7%

compared to the ED visit charges, which grew 8.3% in the same time frame. This study identifies

some variances in ED costs related to facility levels, for example, larger costs are associated with

hospitals that possess greater capabilities, like level I trauma centers. Another group that

experienced significantly larger ED visit were those aged 65 or above and insured through

Medicare. A big portion of this growth is attributable to aging baby boomer generation, of whose

population grew by 25% from 2012 to 2019. Lastly, the Affordable Care Act allowed for a larger

population to secure health insurance and promoted urgent care and primary care visits instead of

the ED, but as Medicaid eligibility expanded, it subsequently increased Medicaid enrollees ED

visits across the nation.

Limitations

Limitations to this study include data collected and misestimation. The authors state that

more sophisticated accounting methods could yield more precise data which would lead to more

accurate cost estimates. This study may have underestimated the cost of patients who were

admitted from the ED, since NEDS only shows ED data, because patients admitted from the ED

are actually associated with lower ED costs. Lastly, the ICD-9 to ICD-10 transition in 2015 may

have affected the accuracy of diagnosis coding, and thus misrepresented data related to costs.
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References

Pickens, G., Smith, M., McDermott, K., Mummert, A., & Karaca, Z. (2022). Trends in treatment

costs of U.S. emergency department visits. American Journal of Emergency Medicine,

58, 89-94. https://pubmed.ncbi.nlm.nih.gov/35660368/