Why Heading to the Emergency Room (ER) for a Mild Headache is Hurting Healthcare - And What We Can Do About It

 Ever Had a Mild Headache and Rushed to the ER?

It’s late at night, and a mild headache starts creeping in. Even though you’re exhausted, you still think - what if it’s something serious? Your search on Google for causes quickly spirals into self-diagnosis: Could it simply be stress or dehydration? What if it was something more serious? The emergency room is open 24/7 and your insurance covers it. Getting checked is probably the safest option, so you change and leave the house.

You’re not alone. Millions of insured individuals make a similar decision every year: They think they have some serious condition and go to be ‘better safe than sorry’. But what if your visit is the reason someone with a life-threatening emergency has to wait longer for care? This behavior is a concept known as moral hazard, where individuals change their behavior when they’re protected from the financial consequences of their actions.

Understanding Moral Hazards in Health Insurance

At its core, health insurance serves to protect us from crippling medical expenses, it is a form of contract between a company and a consumer, where the company agrees to pay for the insured person’s healthcare costs in exchange for monthly payments from that person (Kagan, 2024).

So? What’s wrong? Surely, if you paid for insurance, you should be able to use it however you want, right? This is where problems arise; when people know that insurance covers the bill, their behaviors change. They may be more likely to visit the ER for minor issues

How big is the problem?

●     56.7% of ER visits in the US could be classified as non-urgent (Tapia, Howard et al. 2022)

●     Average ER visit cost $530 in 2017, but since insurance companies could pay these sizable amounts, consumers would feel more incentivized to go the ER (Moore & Liang, 2020)

It leads to negative externalities, where the cost of one person’s choice spills onto others, meaning one person’s decision could negatively affect the experience of others. In this case, one non-urgent patient using the ER would negatively impact the patients who need urgent care.

When ER Delays Turn Deadly

Overcrowded ERs don’t just mean longer wait times - they could be the difference between life and death.

A striking example is the case of Nevaeh Crain, an 18-year-old from Texas. In October 2023, Nevaeh sought emergency medical care three separate times due to severe abdominal pain and worsening symptoms. During her first visit, she was diagnosed with strep throat, and then sepsis, and during her final visit, her condition had deteriorated beyond saving. Tragically, Nevaeh passed away (Dunbar, 2023).

While this case is rather extreme, it highlights the devastating consequences of overcrowded ERs and delays in medical intervention.

Why Do So Many People Overuse the ER?

So why do people rush to the ER for minor issues? The answer is very simple: it’s convenient, and there’s coverage for it. Three main factors can be attributed to why people overuse the ER.

Firstly, there is the “Cost-Free” mentality. When people have comprehensive insurance, it often gives one the illusion that ER visits are free, even if they have to pay a small amount, the financial burden isn’t directly felt, and so patients have less incentive to choose cost-effective alternatives.

In addition, people could simply assume that they will be treated faster in the ER. While that may occasionally be true, ERs normally prioritize patients based on severity, so a patient’s visit might not necessarily be faster if they went to the ER with a minor inconvenience.

Finally, there is also the chance that patients simply don’t know their options. Urgent care centers and walk-in clinics could sometimes treat wounds and small injuries faster than ERs, yet many people may still go to the ER because they don’t realize these alternatives exist.

In that case, is there an actual way to solve this?

As such, it is important to address these issues to make sure that patients who need urgent care can be treated on time and that hospitals are not wasting resources and time. There are various ways to prevent the overuse of the ER in patients.

One would be the introduction of higher copayments for non-emergency ER visits. However, while this could reduce unnecessary visits, it might also discourage low-income patients from seeking care, leading to worsened health outcomes. Striking a balance between deterring unnecessary visits and ensuring affordability is key. Hence, pricing strategies such as price incentives can be used to guide consumer behavior. By increasing the cost for ER, patients with non-urgent cases are nudged to more efficient choices, like clinics.

Another potential solution is expanding access to alternative care options, such as telemedicine and urgent care centers. Telemedicine, in particular, provides a way for patients to consult a doctor remotely, reducing unnecessary ER trips while ensuring that they receive medical guidance. Some hospitals have also implemented ER diversion programs, where non-emergency patients are directed to more appropriate care settings.

Conclusion: Smarter Healthcare Choices for a Better System

Hence, moral hazard in health insurance isn’t just an economic theory — it’s playing out in hospitals daily, causing problems such as ER overuse, longer wait times, and higher healthcare costs.

To solve this, a balanced approach is required, a method that can discourage non-urgent patients from going to the ER for unnecessary purposes whilst also ensuring that they get the help they need. As such, tiered copayments, increased awareness of medical aid available, and expanded urgent care options can all help ensure the ERs are reserved for true emergencies.

So, next time you have a mild headache or a fever, ask yourself: Is the ER the only way to go about this? Isn’t there a better, faster alternative that won’t negatively impact the healthcare system?

Just by thinking this through, you could save a life.

Reference list

Dunbar, M. (2024). Pregnant Texas teen died after three ER visits due to impact of abortion ban. [online] The Guardian. Available at: https://www.theguardian.com/us-news/2024/nov/01/teen-dies-abortion-ban-texas-neveah-crain [Accessed 2 Apr. 2025].

Granlunds, D. (2011). New ER reservation option. [Cartoon] Available at: https://cagle.com/cartoonist/granlund/2011/03/02/90017/new-er-reservation-option [Accessed 2 Apr. 2025].

Kagan, J. (2022). What Is Health Insurance? [online] Investopedia. Available at: https://www.investopedia.com/terms/h/healthinsurance.asp [Accessed 2 Apr. 2025].

Mark (2020). Moral Hazard. [Cartoon] Available at: https://econfix.wordpress.com/tag/moral-hazard/ [Accessed 2 Apr. 2025].

Moore, B.J. and Liang, L. (2020). Costs of Emergency Department Visits in the United States, 2017: Statistical Brief #268. [online] National Library of Medicine. Available at: https://www.ncbi.nlm.nih.gov/books/NBK566654/ [Accessed 2 Apr. 2025].

Tapia, A.D., Howard, J.T., Bebo, N.L., Pfaff, J.A., Chin, E.J., Trueblood, W.A., April, M.D., Long, B.J., Long, A.N., Fernandez, W.G. and Schauer, S.G. (2022). A Retrospective Review of Emergency Department Visits That May Be Appropriate for Management in Non-Emergency Settings. Military Medicine, [online] 187(9-10), p.usab553. doi:https://doi.org/10.1093/milmed/usab553.