Analyzing where Medicare beneficiaries receive care and the relationship between primary care access, outpatient utilization, and emergency department reliance across 51 states and 10 years of data.
ER visits dropped 19.2% during COVID (2020) and remain 11.9% below pre-pandemic levels in 2023. Meanwhile, E&M visits rebounded +2.2% and outpatient visits are flat — suggesting a permanent behavioral shift away from the emergency department.
Inpatient's share of Medicare spending fell from 28.5% (2014) to 23.5% (2023), while outpatient grew from 14.1% to 19.1%. This $5B+ national shift means more care is happening in lower-cost settings.
The strongest predictor of ER visits isn't lack of primary care — it's poverty. States with higher Medicaid-Medicare dual eligible rates have significantly more ER visits (r=0.593). Social determinants outweigh provider supply.
States with lower ER reliance actually spend MORE overall (r=−0.651). Why? Because more primary care access means more total utilization across ALL settings — but with better outcomes and fewer readmissions.
| State | Region | ER/1000 | E&M/1000 | OP/1000 | FQHC/1000 | ER Reliance % | Spend/Capita | Readmit % |
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| Care Setting | 2019 Baseline | 2020 Rate | Drop % | 2023 Rate | Recovery % | Status |
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