NC has 7th-longest ER visit time

North Carolina has the seventh-longest emergency room visit time in the country. 

Patients in the state spend an average of three hours and 15 minutes in the emergency department — 35 minutes longer than the national average of two hours and 40 minutes — according to US Centers for Medicare & Medicaid Services data. 

ER visit times also vary significantly among North Carolina hospitals. 

The longest average ER visit time was at Duke University Hospital, where patients spent an average of five hours and 20 minutes in the emergency department. The shortest was at Swain Community Hospital, at one hour and 15 minutes. 

The federal data does not explain what is driving North Carolina’s longer ER visits. However, some health policy analysts argue that both increased demand for health care services and state policies affecting hospital capacity may be contributing to the trend. 

Medicaid Expansion 

Brian Balfour, the senior vice president of research at the John Locke Foundation, said Medicaid expansion could be contributing to lengthy ER visit times, especially if patient demand is increasing faster than provider capacity. 

North Carolina expanded Medicaid effective Dec. 1, 2023. As of May 1, 2026, more than 725,000 North Carolinians have enrolled through expansion. Overall, Medicaid now covers one in four North Carolinians. 

“An overcrowded Medicaid system makes it difficult for enrollees to find regular physicians, so in turn many end up in emergency rooms instead,” Balfour said. 

Research has long shown that Medicaid patients use ERs at higher rates than people with private insurance, particularly for non-urgent care. 

A North Carolina-focused study published in 2023 noted that Medicaid patients use “disproportionately more ER care than other patients of comparable health.” Citing prior research, the authors reported that Medicaid patients were 700% more likely than privately insured patients to visit ERs for non-urgent health issues. 

According to the CDC, patients covered by Medicaid, CHIP, or other state-based programs had 99 ER visits per 100 people in 2022, compared with 21 visits per 100 people among privately insured patients. 

Certificate of Need laws 

Balfour also said that North Carolina’s Certificate of Need (CON) law could also be contributing to lengthy ER visit times.  

The law requires hospitals to obtain permission from a state commission before building facilities, adding beds, or purchasing certain types of medical equipment. 

A 2021 report by the John Locke Foundation found that CON laws are associated with 30% fewer hospital beds per capita, 13% fewer hospital beds, and 14% longer emergency room visit times. 

The five states with the longest ER visit times all have CON laws. 

The North Carolina Healthcare Association, which represents hospitals across North Carolina, supports the state’s CON law. Its website says the law “ensures healthcare services are right sized for their communities, guaranteeing access for all patients.” 

Carolina Journal asked the association what factors are contributing to lengthy emergency room visits, what steps hospitals can take to reduce them, and whether state lawmakers should consider policy changes to address the issue.  

The association did not respond by publication time. 

State leaders have also raised questions about health care capacity after Raleigh-based WakeMed and Charlotte-based Atrium Health proposed a merger on May 1, 2026. 

On May 4, Wake County commissioners delayed their vote on the merger for at least 90 days after State Treasurer Brad Briner and state Reps. Erin Paré, R-Wake; and Mike Schietzelt, R-Wake, expressed concerns about capacity and quality. 

“NC has 7th-longest ER visit time” was originally published on www.carolinajournal.com.