Emergency Room Visits by Payer (OASIS Detailed Causes, Nested)

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Our calculation from OASIS's counts: each payer's share of ER visits of Georgia residents not ending in admission (admitted visits are in hospital_discharges_by_payer), the payer's visits over all visits of the place, year and cause. These are visits, not people. Unknown payer is in the denominator, so the payers' shares add up to 1. For rates, race or sex, use er_visits_by_cause, which counts the same visits: never add the two. Some county-years reflect a hospital's payer coding. Causes nest: never add them. peachcare (PeachCare for Kids, which began covering children in 1998) has no visit in any place before 2006, so it has no rows then (not recorded, so no value can exist), then 24,113 in Georgia in 2006, 1,314 in 2007 and 660-8,564 a year after: hospitals rarely record it as the primary payer, and its visits are probably counted under other payers (our reading). Statewide shifts between payers (Georgia's shares of visits): Medicaid is 24.4% in 2002, the module's first year, and 28.0% in 2003 (649,047 and 807,802 visits), as Fulton's visits rise from 189,115 to 250,897 (probably visits missing in 2002, our reading). In 2006 Medicaid falls (27.8% to 23.9%) and private insurance rises (29.3% to 31.7%) as PeachCare appears, the year Georgia moved most Medicaid and PeachCare members into managed-care plans (Georgia Families; the link is our reading). In 2007 self-pay jumps from 835,851 visits to 1,084,651 and falls back to 865,273 in 2008 (the county coding blocks below), and all other payers rise from 3.1% to 4.7% and stay higher. From 2008 to 2010 private insurance falls (29.6% to 24.1%) and Medicaid rises (24.1% to 27.8%; the recession, our reading). In 2020 visits fall from 4,159,155 to 3,246,307 (COVID-19), and Medicaid loses the most (1,135,480 to 790,953). Self-pay falls from 24.5% in 2020 to 17.0% in 2023, while Medicaid's pandemic continuous enrollment lasted, and Medicaid falls from 27.8% in 2023 to 22.9% in 2024 (1,088,806 to 921,884 visits; 884,106 in 2025) after it ended, as private insurance rises from 25.3% in 2022 to 34.6% in 2025 (942,158 to 1,406,529 visits; our reading of both). In 154 county-years (63 counties) a payer's share sits far from the county's usual level, mostly for one to a few years before it returns, which probably reflects one hospital's payer coding, not the county's payer mix (our reading; a payer's share more than 25 points from the county's own median over the years, with 300 or more visits). Cobb 2007: self-pay 81.7% of 156,158 visits, against 24.3% in 2006 and 26.6% in 2008; the 22 counties flagged in 2007 make 93% of Georgia's 2007 rise in self-pay and 90% of its 2008 fall. Dougherty 2016: all other payers 81.2% of 32,798 visits, against 23.0% in 2015 and 6.0% in 2017; the 12 counties flagged in 2016 make 74% of Georgia's 2016 rise in all other payers and more than all (124%) of its 2017 fall, and the 2022 counties 42% of its 2023 fall. Some runs last years (Sumter 2009-2016, Randolph 2013-2020, Upson 2017-2022), and those flagged in 2025 (Dade, Fannin, Franklin, Greene and Hart) may not have ended. All of them: Atkinson 2007-2008; Bacon 2014; Baldwin 2022; Bibb 2002; Calhoun 2016; Camden 2009-2011; Carroll 2002-2003; Chatham 2008; Cherokee 2007; Clay 2012-2013, 2015-2017; Cobb 2007; Coffee 2007-2008; Crawford 2022; Crisp 2002; Dade 2021-2025; Dawson 2007; Dougherty 2016; Douglas 2007; Early 2011-2013; Fannin 2023-2025; Fayette 2002, 2007; Forsyth 2007; Franklin 2025; Gilmer 2002-2005; Glascock 2007; Glynn 2008-2011; Gordon 2007; Grady 2007; Greene 2025; Haralson 2003; Hart 2025; Henry 2002-2003, 2005-2009; Houston 2012; Irwin 2007; Lee 2016; Lumpkin 2003-2005; Macon 2016; McDuffie 2007-2009; McIntosh 2008-2011; Miller 2014; Morgan 2012-2017; Murray 2011, 2013; Paulding 2007; Peach 2002, 2022; Pickens 2002-2004, 2007; Randolph 2013-2020; Schley 2002, 2007, 2010-2016; Spalding 2002; Stewart 2008-2009; Sumter 2002-2004, 2007, 2009-2016; Taylor 2021-2022; Terrell 2016; Thomas 2007; Tift 2007; Turner 2007; Upson 2017-2022; Walker 2021-2023; Warren 2007-2009; Webster 2008-2009, 2013, 2015-2016; Whitfield 2011, 2013; Wilkes 2003; Wilkinson 2022; Worth 2013, 2015-2016. Compare a county's shares across years with care. Unknown payer is 0.9%-3.7% of Georgia's visits a year before 2012, at most 0.17% in 2012-2018 and 0.3%-1.0% from 2019, but up to 82.2% of a county's (Sumter 2007; from 2012 at most 53.5%, Fannin 2023), which lowers every other payer's share there. The payer is the primary payer as recorded on each record, and coding shifts show as jumps between payers. OASIS counts HMO and other managed care under private insurance and does not say where Medicare Advantage or Medicaid managed-care plans fall (our caution). An ER visit is one visit to the emergency room of a non-federal hospital in Georgia, by the patient's county of residence, that did not end in an inpatient admission: OASIS counts a patient seen in the ER and admitted as a hospital discharge (hospital_discharges_by_cause, with payers in hospital_discharges_by_payer) and keeps the two mutually exclusive, so no visit is counted in both. Visits of Georgia residents to other states' hospitals are not counted, so counties near another state's hospitals have few visits and their shares describe only the visits counted. er_visits_by_cause names the county-years whose visits drop for one year (missing hospital records, our reading): there a county's shares describe only the visits reported. Causes are coded in ICD-9-CM until September 2015 and ICD-10-CM from October 2015, which breaks some causes' series (OASIS's reporting-issues page), 2015 mixing both; lack_of_oxygen_to_the_fetus has no rows from 2016 (P20-P21, codes ICD-10-CM does not have, so no visit can carry it), and sids is 0 in every place from 2016 (an undocumented break), so its shares from 2016 are NULL. There is no payer total row: num_er_visits_all_payers is every visit of the place, year and cause. A share is NULL only where the place had no visits for the cause in the year. 2025, the newest year, was added to OASIS on 2026-09-03; OASIS marks no year provisional. Counties add up to Georgia. OASIS's payer 'rates' are not served: each divides a payer's count by the whole place's population, not by that payer's enrollees. Also not served: OASIS's deduplicated measures (people rather than visits), significance flags and percents. tract_geoid is always NULL.