In recent years there has been significant media attention to the issue of hospital emergency department (ED) closures and growing concern that access to emergency care is eroding. Hospital EDs play two vital roles in our health care system: They provide access to 24-hour outpatient emergency health services and they serve as a critical point of entry into the inpatient hospital setting. Each year Californians average more than 10 million ED visits, resulting in more than 1 million patients being admitted to the hospital. Thus, the availability and proper functioning of EDs are of vital interest to all Californians. California's hospital emergency services are largely provided within a voluntary and decentralized system, with some coordination at the local level. However, hospitals operate in a rapidly evolving and complex marketplace; they face financial and economic pressure from a variety of sources including price competition under managed care and cost-containment initiatives by third-party payers. At the same time, population growth and aging of the population are contributing to rising demand for emergency care. To assess how these pressures are impacting hospital EDs in the state, the California HealthCare Foundation funded the Center for Health Financing, Policy and Management at the University of Southern California to document the supply and demand aspects of hospital emergency care. This issue brief analyzes key trends in the utilization and capacity of California's hospital-based EDs.
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