Access to Emergency Services

A national report card finds that demand for emergency care is growing fast and the nation is unable to meet this demand, although states are adopting policies to increase citizens' access to care.

  Download the PDF Version of this Report

Demand for emergency care is growing fast and the nation is unable to meet this demand.

  • Emergency department visits in the U.S. increased by 36 percent to 119 million in 2006, up from 90 million in 1996.1 This increase can be linked to both the aging of the population and the growing number of individuals who cannot afford medical care or have nowhere else to go for care.2
  • Although the average number of emergency departments nationwide is 20 departments per 1 million people, the number ranges from as many as 66 per 1 million people in South Dakota to as few as 6.6 per 1 million people in New Jersey.2
  • Between 1993 and 2003, the number of hospitals in the U.S. decreased by 703, the number of hospital beds dropped by 198,000, and the number of emergency departments fell by 425.3
  • Shortages of health care professionals affect access to emergency care. This can be particularly challenging in rural areas where 20 percent of America’s population reside but only 9 percent of the nation’s physicians serve.5

As a whole, the nation is doing poorly in providing access to emergency health care services.

  • The American College of Emergency Physicians graded the states on health care issues and gave an overall average grade of D- in providing access to emergency care.2
  • The District of Columbia was the only recipient of a grade of A. It has the highest rate of health care professionals and lower-than-average rates of uninsured. It also benefits from being in a highly populated area with high numbers of specialists, physicians who accept Medicare, staffed inpatient beds and high number of Medicaid recipients.2
  • More than half the states received a D or an F. The states, by ranking, receiving a failing grade include California, Florida, New Mexico, Arizona, Texas, Nevada, South Carolina, Georgia, Washington, Idaho, Oregon and Oklahoma.2

States are taking action to increase access to emergency care.

  • States are increasing Medicaid fee levels to attract providers and assure access. From 2004–2007, at least 31 states increased physician rates in their Medicaid programs. In 2008, 27 states reported increases and 29 states plan to increase physician rates in 2009.4
  • States are focusing on covering the uninsured to assure access to needed health care services.
  • Nearly all states have loan forgiveness programs and incentives in place to attract physicians and other health care providers to medically underserved areas.6,7
  • States are increasingly reimbursing for telemedicine services to provide greater access in remote areas. At least 24 states reimburse for telemedicine in their Medicaid programs.8

  Download the Excel Version of the Table:  "National Report Card on Access to Emergency Care, 2009"


1 Centers for Disease Control and Prevention. "National Health Statistics Report, No. 7." August 6, 2008.

2 American College of Emergency Physicians. "The National Report Card on the State of Emergency Medicine." 2009

3 Institute of Medicine.  "Committee Report on the Future of Emergency Care in the United States Health System." June 2006.

4 Kaiser Commission on Medicaid and the Uninsured. “Headed for a Crunch: An Update on Medicaid Spending, Coverage and Policy Heading into an Economic Downturn."

5 "HHS Rural Task Force Report to the Secretary." July 2002.

6 Council on Graduate Medical Education. "Traditional Approaches by States to Financing Medical Education."

7 McKinley, Andrew. "Promoting access to care in rural and underserved areas: is there a physician shortage in the United States? Some statistics say “no.” Others say “yes.

8 Institute for Child Health Policy, “Telemedicine for CSHCN: A State-by-State Comparison of Medicaid Reimbursement Policies and Title V Activities."  July 2005.

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