Emergency room (ER) visits play a major role in the health of people in the United States. In recent years, the percentage of care given at ERs has grown significantly.

The Centers for Disease Control and Prevention (CDC) reports that 1 in 5 people in the U.S. had one or more ER visits over a 12-month period in 2007. In 2008, there were nearly 124 million visits to the nation's 4,000 ERs.

In fact, a recent study revealed that nearly half of all medical care in the U.S. is delivered at hospital ERs. David Marcozzi, an associate professor in the UMSOM Department of Emergency Medicine, co-director of the UMSOM Program in Health Disparities and Population Health, and an ER physician at the University of Maryland Medical Center Emergency Department, led the research.

Marcozzi and his colleagues examined publicly available data from several national healthcare databases, which covered all 50 states and the District of Columbia between 1996 and 2010. Their objective was to determine the contribution of ERs to the healthcare received by Americans between 1996 and 2010 and to compare it with the contribution of outpatient and inpatient services using National Hospital Ambulatory Medical Care Survey and National Hospital Discharge Survey databases.

Over the 14-year period, 3.5 billion ER visits, outpatient visits and hospitals admissions took place, with ER visits increasing 44 percent. For 2010, there were nearly 130 million ER visits compared with almost 101 million outpatient visits and nearly 39 million inpatient visits.

ER visits are generally unexpected and unplanned, as opposed to inpatient visits, which often involve a hospital stay. Emergency physicians treat patients of all ages and incomes, never turning patients away like other medical providers.

ERs are more efficient, effective and timely in diagnosing and treating many acute medical conditions than physicians' offices because they have immediate access to all the hospital's equipment and services, including diagnostic imaging, laboratory testing, pharmaceuticals and other medical specialists. Many conditions, such as heart attacks, strokes and major trauma, are critically dependent on timely diagnosis and treatment to ensure good outcomes and can only be treated in an emergency department.

But there are other factors that contribute to the use of ERs.

For example, the study revealed that a strong correlation exists between income levels and a tendency to seek treatment in ERs. Among adults 18-44 years of age, the uninsured were more likely than those with private insurance to have at least one ER visit.

Medicaid patients are more likely to have reported multiple ER visits than people with private insurance, as well as the uninsured. According to the CDC, people on Medicaid may seek emergency treatment more often than those with private insurance coverage or the uninsured because of higher rates of disability and chronic medical conditions.

As family income increased, the likelihood of having visited an ER decreased. Income differences were more pronounced than those based on age, race or ethnicity. African-American patients were also more likely than other groups to visit ERs. The rate was even higher for urban African-American patients who used ER care 59 percent of the time during 2010.

Controversy about using ER resources for nonemergency cases continues, with experts agreeing that ERs are covering for deficiencies in inpatient and outpatient services as well as the lack of prevention strategies. All of this could change, according to Marcozzi, were care delivered in ERs connected with care delivered by the rest of the healthcare system.