Many continue to rely on ERs

14% used hospital before family doctor

The vast majority of Bay State residents have health insurance and a primary-care physician, but many are still relying on hospital emergency rooms for care that could have been handled less expensively by their family doctors, according to a new survey.

Fourteen percent of adults surveyed said they had trekked to the ER at least once in the past year for ailments that they thought could have been treated by their doctors, if he or she had been available, according to the poll by the Boston Globe and Blue Cross Blue Shield of Massachusetts Foundation.

People with lower incomes - roughly $64,000 for a family of four - were about twice as likely to use the ER as those from households with higher incomes. Similarly, respondents whose primary language was not English were also about twice as likely to use ERs for nonemergencies, compared to their English-speaking counterparts. Hispanics and nonwhite residents were also about twice as likely to head to the ER for illnesses that their primary-care doctor typically could have handled.

Emergency room usage for routine care is carefully watched because the expense drives up overall health spending.

The survey findings underscore longstanding disparities in the healthcare system, said Dr. JudyAnn Bigby, the state's secretary of health and human services, and a champion of eliminating such disparities.

"The issue of whether primary-care providers are available when people are able to see them is going to affect lower-income people who are more likely to not be able to take time off in the middle day without losing pay," she said. "Non-English speakers are also more likely to be working in a job with that situation."

But the findings, Bigby said, also show that much progress has been made since 2006, when Massachusetts overhauled its healthcare system and became the first in the nation to require everyone to have health insurance.

"I never expected, after less than two years of a concerted effort to get everybody insured, that these differences would go away," she said. "I acknowledge there are some differences, but the progress that has been made is astounding to me."

The telephone survey of 1,018 adults conducted by the University of New Hampshire Survey Center found that about 96 percent of those surveyed have health insurance and that 92 percent have a primary healthcare provider. The margin of error was plus or minus 3.1 percentage points.

A number of other surveys in Massachusetts and nationwide have indicated a shortage of primary-care physicians, as debt-laden medical students head, instead, into more lucrative specialties. Although most respondents in the Globe's survey said they had a primary-care provider, the double-digit usage of emergency rooms for routine care suggests many people are still finding it tough to connect with a doctor during normal business hours.

Mary Nikolaides, a 58-year-old nurse from Dedham, is among those surveyed who said ERs can be more convenient.

"You are going to seen right away," Nikolaides said. "If you call your doctor, you might not be seen till tomorrow."

Nikolaides, who has health insurance and a regular doctor, said she has long relied on the ER, even though it costs more money, because she knows she can get faster test results. Her insurance charges a $50 copayment to use the ER, and $15 for a doctor's visit.

In Reading, Nancy Servello, a 46-year-old mother of two, also has health insurance, a family physician, and heftier copayments for ER usage. Still, she said she has gone twice in the past year.

"I felt I had no choice," Servello said. "I had a kid who is nauseous with a headache, and you call the pediatrician and they say, 'Go to the ER.' And that's annoying. The emergency room is basically a Band-Aid. They don't really address what your problem is."

A recent survey by the Massachusetts Medical Society found that waiting times to see a family physician have grown in the past year, along with the ranks of the newly insured. State lawmakers this summer approved financial incentives, and other programs, to attract primary-care doctors. But healthcare leaders say the new measures will take several years to ease the crunch.

Kay Lazar can be reached at klazar@globe.com.