A forty-year-old lady with a tender breast bone that she called chest pain in the hospital emergency department, spent four hours in an exam cubicle from, 8 PM to 12 MN. The triage team had ordered a chest x-ray, electrocardiogram and a number of lab tests. She was told at midnight that it would be another six hours before a doctor would be able to see her. She then left with the pain did not changed. The next morning, she scheduled an urgent office visit, went by the emergency departments and brought the x-rays, ECG and lab work to the office with her.

Her tender chest pain was costochondritis, a benign painful cartilage between the sternum and the ribs, which took ten seconds to diagnose. I immediately gave her two extra strength acetaminophen tablets and continued to see other patients. On returning to her room twenty minutes later she felt much better and returned home. The chest x-ray, ECG and laboratory work were all unnecessary costs, as was the entire emergency visit.

How can this be avoided? As long as ER visits are relatively free to the patient ($15 to $50 ER copay are not market based and thus have no major effect on excessive utilization), there will continue to be overutilization and exorbitant costs. A percentage copayment returns the ER to the market-based controls. If the patient pays a percentage of every test and procedure, the patient will put a stop to excessive utilization and use normal channels of health care,like the doctor’s office visit, which is the most cost-effective health care expenditure.