Meanwhile, the number of emergency departments is declining as the number of ED visits to hospitals is increasing.
Lee suggests that the cost estimates are based on calculations that consider emergency department services as a fixed cost, and don't take into consideration what happens when they become crowded and have to bring in more staff, or special specialty expertise.
There are also concerns that many patients who seek care on the emergency department are not experiencing true emergencies. They may be using the ED instead of an office visit to a primary care physician, which would be cheaper and more appropriate for their symptoms.
Lee says he realizes that his suggestion that ED care is a lot more expensive than people think may prompt more accusations that ED care is wasteful and unnecessary, or inefficient.
However, he says, it should make people realize that much of the time the ED is ruling out potentially harmful conditions, such as determining that the source of stomach pain in a patient who was in a motor vehicle accident is not internal bleeding.
"The total cost of care isn't what's relevant here," he says. "My sense is that trying to divert care (away from the emergency room) isn't going to save a lot of money in the aggregate. It's not always going to be clear what's a true emergency and what's not."