ED use of military beneficiaries

Context: The United States and Canada have ED use rates of approximately 40 visits per 100 population. Although the military network of hospitals shares many features with the civilian sector, this "system within a system" has universal health insurance coverage and provides an opportunity for comparison. Objective: The purpose of the study was to describe the emergency department (ED) use rate of a population of fully insured military health care beneficiaries. Design: A nonconcurrent database analysis of billing and visit data was performed to establish the ED use rate of military beneficiaries. Setting: The study operated within a global military health care system. Patients: The study involved military beneficiaries presenting to military and civilian EDs. Main Outcomes: The number of ED visits, demographics, and final diagnostic categories were analyzed. Descriptive methods were used to report data from fiscal years 2002 to 2007. Results: The military beneficiary population averaged 9.1 million persons during 2002 to 2007, and the corresponding ED use rate was 40.0 visits per 100 beneficiaries. There was an upward trend with the rate peaking in 2007 at 47.0. The number of military EDs declined from 76 in 2002 to 53 in 2007, whereas the average annual ED volume increased. The 95% confidence intervals are within ± 0.02% for all reported values. Conclusion: The ED use rate was 40 visits per 100 military health care beneficiaries from 2002 to 2007. This is very similar to rates reported for US and Canadian populations. Near universal insurance coverage does not necessarily result in reduced ED use. Military EDs share the civilian sector challenges posed by steadily rising patient volumes.