Access and use of emergency services: Inappropriate use versus unmet need

Increasing political and public health policy concern has arisen in response to increasing use of emergency departments (EDs). Visits to EDs have increased more than 600% during the past half century, with an estimated 100 million people in the United States seeking care in an ED this past year. This dramatic growth has been interpreted by some as clear evidence of overuse of EDs, specifically for nonemergent problems. A commonlt held perception is that using emergency services for nonemergent problems is both more expensive and less effective that care provided in other ambulatory settings, and henceforth an inappropriate use of the ED. The failure of an adequate public health policy has thrust hospital EDs and emergency care providers into the middle of a contentious debate concerning what represents approproate use of emergency services and how best to serve the unmet needs of the groeing number of Americans who use tham. The author examines the social and economic factors that have contributed to this problem and examines the question of what constitues approproate usage of emergency services.