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Emergency Department Visits Exceed Affordability Threshold for many consumers with private insurance

The high cost of emergency care may impact patients’ ability to afford treatment, with almost half of US adults reporting they have delayed care due to costs. This analysis uses 2019 insurance claims data from the Merative MarketScan Commercial Database, which captures privately insured individuals with large employer health plans, to assess the total and out-of-pocket costs of emergency department visits for this group, overall and by diagnosis and severity level. It also looks at which services contribute most to the costs of emergency department visits and examine regional variation in emergency department costs and provides a demographic profile of consumers who visited the emergency department.

It find that enrollees spend $646 out-of-pocket, on average, for an emergency department visit. The most expensive components of most emergency department visits include evaluation and management charges, imaging, and laboratory studies. Cost varies by disease, visit complexity, and geographic region.

The full analysis is available through the Peterson-Kaiser Health System Tracker, an online information hub dedicated to monitoring and assessing the performance of the U.S. health system.

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