False beliefs abound. In few areas of public discussion is this more true than health policy.

One of these false beliefs is that emergency care is terribly expensive, and that we could save a lot of money if we could just somehow see to it that everyone who goes to a hospital emergency department with a problem that is not a true emergency could be re-directed somewhere else.

So … is that true or false?

As with so many other things, it depends on how you look at it. And, with a complex proposition such as this one, it is important to recognize that it has several interdependent parts.

If you’ve been a patient in a hospital emergency department (ED) for something that you might have seen your primary care doctor about, if you could get a timely appointment, you surely noticed that the bill was higher than it would have been at the doctor’s office. There are, as you may know, two fundamental reasons for that.

First is that the ED has a lot more “fixed costs” (or overhead) that must be covered by revenues. Second is that we have to engage in “cost shifting.” We have a lot of patients who do not or cannot pay. So the hospital must bill paying customers more to make up for the ones who pay little or nothing.

Imagine going to McDonald’s and finding that the price of a Big Mac had doubled because half of Mickey D’s customers weren’t paying for their meals, and so the paying customers had to pick up the tab. … That doesn’t happen at McDonald’s, because they don’t give everybody chicken nuggets regardless of ability to pay. In the ED, we do exactly that. We do it partly because we believe in certain principles of social justice and partly because there is a federal statute that says we must.

So the cost is higher after accounting for overhead, and the price difference is even bigger. And if you have private insurance, the insurance company has ways of discouraging you from using the ED when you could go to your doctor’s office instead. For example, if you were sick, but not sick enough to be hospitalized, your ED co-pay might be $100, whereas in the office it would have been $10. And yet people go to the ED anyway. There are lots of reasons for that: convenience, resources available in the ED, and perceptions of the quality and comprehensiveness of care are perhaps foremost among them.