Poor, Uninsured Don't Fill Emergency Rooms -- Study

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stoic

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Saw this on yahoo... thought I'd post.

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WASHINGTON (Reuters) - A new study on emergency rooms disputes the common wisdom that the poor and uninsured are filling them up.

In fact, more than 80 percent of patients seen in emergency rooms have health insurance and a usual source of health care such as a primary care physician, doctors reported on Tuesday.

"Contrary to popular perception, individuals who do not have a usual source of care are actually less likely to have visited an emergency department than those who have such care," said Dr. Ellen Weber, an professor in the division of emergency medicine at the University of California San Francisco, who led the study.

For the study, Weber and colleagues looked at interviews of nearly 50,000 adults visiting emergency departments in 2000 and 2001.

People without health insurance were no more likely to have had an emergency visit than those with private health insurance, they told a meeting of the American College of Emergency Physicians (news - web sites).

People without a regular doctor or clinic were 25 percent less likely to have had an emergency visit than those with a private doctor, the researchers found.

Their study, also published in the Annals of Emergency medicine, found that 83 percent of emergency department visits were made by people who had a doctor, clinic or were members of a health maintenance organization.

Eighty-five percent had medical insurance and 79 percent had incomes above the poverty level.

"The mistaken belief that emergency departments are overcrowded by a small, disenfranchised portion of the U.S. population can lead to misguided policy decisions and a perception by hospital administrators that emergency patients are not as valuable to the institution as patients having elective surgery," Weber said in a statement.

"But our findings indicate that emergency departments serve as a safety net, not just for the poor and uninsured, but for mainstream Americans, and in particular those with serious and chronic illness."

MAJORITY HAVE INSURANCE

A spokesman for the American Hospital Association said he was studying the report but added, "That is not surprising because a majority of people have insurance."

An estimated 45 million Americans lack health insurance, but that leaves 85 percent of the population with coverage, either public or private.

Hospitals have long complained that their emergency rooms are overcrowded. Between 1992 and 2002, emergency department use climbed 23 percent, from 89.8 million visits to 110 million visits.

The 1986 Emergency Medical Treatment and Labor Act requires any hospital taking part in Medicare -- the state-federal health care insurance program for the elderly and disabled -- to provide "appropriate medical screening" to anyone showing up at an emergency room and asking for it.

Hospitals say the rules have burdened their emergency departments with poor and uninsured patients seeking care for everyday conditions. Many have closed emergency facilities in recent years.

"Many insurance programs, and particularly public and private HMOs, require beneficiaries to have a primary care physician, which may be expected to improve overall health and health care," Weber said.



"But the continued rise in emergency visits implies that such programs have not had a substantial impact on overall emergency department use."

Dr. Steffie Woolhandler of Harvard Medical School (news - web sites) and Physicians for a National Health Program agreed. "Many emergency room users have chronic health problems such as congestive heart failure," said Woolhandler, who advocates for universal national health insurance.

http://news.yahoo.com/news?tmpl=story&u=/nm/20041019/us_nm/health_emergencies_dc
 
This doesn't surprise me as we all know that the crowding in the ED is due to the elderly with chronic problems and younger people disabled by chronic problems. All of those people are "insured" (medicare or medicaid) by definition.

stoic said:
Eighty-five percent had medical insurance and 79 percent had incomes above the poverty level.

"The mistaken belief that emergency departments are overcrowded by a small, disenfranchised portion of the U.S. population can lead to misguided policy decisions and a perception by hospital administrators that emergency patients are not as valuable to the institution as patients having elective surgery," Weber said in a statement.

"But our findings indicate that emergency departments serve as a safety net, not just for the poor and uninsured, but for mainstream Americans, and in particular those with serious and chronic illness."

Where this article is misleading is that it tries to say that the indigent and ED abusers are not a burden on the ED. That couldn't be furthur from the truth. these "small, disenfranchised portion of the US population" sucks up a huge amount of resources and negatively affects care across the board. They may not be the majority of the overcrowding but they do have a massive impact.
 
The article *seems* to go against my admittedly limited experience in the emergency room. But I'll admit to assuming certain patients either did or didn't have insurance based on appearances/attitude/apparent education level.

Maybe next time I'm shadowing I'll actually do a little comparasion study.
 
Agree with DocB. Not all "insurance" is equal, and the article makes it sound as though the kind suburban-dwellers get through the HMO at work is the kind 85% of people have. Yes, many patients can whip out some sort of state insurance card when they see us triage. I estimate of the hundred or so people I saw in my most recent shift out there, about 20 to 25 of them volunteered the info that they had no insurance. And I'm the tech, so they talk to me first; I get 'em in the computer, and then the RN does a screening interview before they register. We don't ask, and we don't care, but if that many people are sharing it, I gotta believe the actual number is higher.
 
I wonder how many businesses would find it a victory that "only" 20% of their customers don't pay their bills.
 
Sessamoid said:
I wonder how many businesses would find it a victory that "only" 20% of their customers don't pay their bills.

The same number of businesses that get paid by the reimbursement model (deliver the goods and hope against hope to get paid). Health care as an industry will always be screwed because we operate this way.
 
Perhaps our viewpoint is biased towards the urban county-type of hospital where, undeniably, the EDs support a large uninsured population?
 
EMApplicant said:
Perhaps our viewpoint is biased towards the urban county-type of hospital where, undeniably, the EDs support a large uninsured population?

that's what immediately popped into my head after reading this article. i'll have to get my hands on a copy of the article to take a look at where the study was done.
 
EMApplicant said:
Perhaps our viewpoint is biased towards the urban county-type of hospital where, undeniably, the EDs support a large uninsured population?

I work at a Kaiser ED in LA, and 20% of the patients we see are non-Kaiser members. Of those, probably about 1/2 - 2/3 are uninsured. Definetly not a county type of place...
 
Sure the populations at city places may be skewed but that matters - those places are caring for the majority of patients visiting the ED. If your community hospital (with no subspecialty backup) has a payor mix of 90% insured and 10% uninsured they are going to be a lot more profitable than places with the 85-15 ratio seeing lots more patients and sicker patients (due to referalls for subspecialty care). So great, the overall ratios aren't that bad, but that doesn't mean they aren't bad for some particular hospitals, and that those hospitals are in financial trouble because of it.
 
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