Date of Award

January 2020

Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Arjun Venkatesh


Introduction: Healthcare spending in the US is among the highest in the world and continues to grow year-over-year despite outcomes comparable to or worse than other nations. This spending has translated to extensive patient burden and high out-of-pocket costs for many individuals. Despite high costs to both systems and individuals, patients continue to pursue expensive care options such as emergency department care over other appropriate alternatives. Here, we assess patient understanding of emergency room costs and influences on their decisions to pursue emergency department care.

Methods: Adult patients presenting to the emergency department for conditions not meriting hospital admission or transfer were surveyed to collect information on pre-arrival considerations, referring parties, cost estimates, educational attainment, employment status, and other demographic factors. Upon full study completion, hospital data on charges, payments made, insurers, and other administrative factors will be drawn for further analysis.

Results: Senior citizens, retired individuals, individuals with full-time employment, and those with high educational attainment were more likely to come at the suggestion of a doctor, family member, friend, or other referring party. Many insured individuals were less likely to consider alternative centers of care. No demographic factor studied appeared to affect patient propensity to consider prices prior to arrival at the emergency department. Patients provided a wide range of estimates for overall care costs (mean $4,453.94; SD $6,384.81) and for personal out of pocket costs (mean $287.73, SD$804.86) and many expressed inability to provide any numerical estimate whatsoever.

Discussion: These data suggest influencing patient emergency care seeking behavior may prove quite difficult. Measures serving as proxies for information exposure were limited in impact on care-seeking decisions. Individuals with cost markers associated with adequate insurance coverage or overall socioeconomic status seemed even less likely to consider lower-acuity, lower-cost alternatives. Many patients throughout the study in a variety of circumstances appeared to treat the question of price considerations itself strange or absurd, perhaps suggesting some component of societal attitudes. Any efforts to lead patients to consider price are further undercut by a general lack of awareness about prices as well as a disconnect between prices and out-of-pocket costs. Further study is needed to adequately assess effects of high cost-sharing plans and supply-side adjustments.


This thesis is restricted to Yale network users only. It will be made publicly available on 09/10/2022