ER Overcrowded With Whom?
Conventional wisdom has always been that Emergency Rooms are stuffed to overflowing by the uninsured. Without a regular doctor to go to, most health experts say, those without health insurance have little choice but to flock to the ER with the slightest sniffle or fever. An ER visit is quite expensive, but how many of the uninsured end up either receiving or paying these bills?
When the Centers for Disease Control and Prevention reported that the number of visits to emergency rooms nationally rose 19% from 1995 to 2005, even as the number of hospital ERs fell by 9%, most experts continued to believe that it was the uninsured who were clogging the shrinking ERs. As hospitals relocate to the suburbs, a growing trend, they would likely be dealing with a growing number of insured patients, potentially leaving behind the uninsured blocking their ambulance bays with minor complaints.
Is conventional wisdom correct? Apparently not.
A new study published in JAMA this past week has suddenly called the conventional wisdom into question. The study reviewed 127 articles from 1950 to 2008 and determined that “available data do not support assumptions that uninsured patients are a primary cause of ED overcrowding, present with less acute conditions than insured patients,or seek ED care primarily for convenience.”
According to this study, uninsured patients are far less likely to visit the ER for non-urgent care than insured patients. 17% of Americans are uninsured, but they account for only 10-15% of ER visits.
What are the likely reasons for this trend?
* Today’s managed care type of health insurance doesn’t give you instant access to your physician for minor problems. There are fewer primary care doctors these days. Unable to get an appointment or timely visit, you may turn to the ER.
* Whereas the uninsured could get hit with a large bill contrary to popular wisdom, on the other hand, an insured patient will only have to deal with the co-pay.
* Uninsured patients may not be in the habit of seeking medical care for minor complaints, whereas health insurance without deductibles may encourage or support hypochondria, or worry that leads to an ER visit.
* Laws keep the ER from turning you away, so if you have insurance, you will be seen and you won’t have to pay for it.
Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News Medical Contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: the Truth About the Epidemic of Fear” and “Bird Flu: Everything You Need to Know About the Next Pandemic”. Read more at www.doctorsiegel.com
Tags: Dr. Marc Siegel, emergency room, ER, hospital, insured, JAMA, overcrowded, uninsured
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You do not address the number of Medicaid patients who turn to the ER. I had guardianship of my grandson who was covered by Medicaid. It was a real eye-opener. It was difficult to find a decent dr. who accepted it. We were constantly told by the dr. office to take him to the ER. I spent so many hours in the ER waiting for him to be seen for things like ear infections. What a nightmare! But of course, we were not billed for the treatment. I have insurance for myself with a heftly co-pay and deductable and I only use the ER for myself if I am desperately sick. As a taxpayer it always made me furious to have to use the ER for the baby, but I had no other choice.
Emergency room care since 1950 has changed drastically, in part due to the changes in Insurance and the general population. Perhaps it is true that the ER’s are not crowded with the uninsured, but it is crowded with the welfare recipients that are unable to find a doctor that will accept these patients, as the frustrated grandmother of the previous post made.
Living in California, and other border states, such as Arizona, New Mexico and Texas sure gives a different picture than one would get in most other states. Our ERs are crowded with illegal aliens that cannot be turned away, their children who need treatment for the normal ailments that would normally be taken care of in a doctors office, It is not unusual to walk into an ER and see many scared parents with a sick child that have nowhere else to turn. Some have welfare, some do not, but their effect on the ER is profound.
The ones that do not have insurance, more than likely, if they end up paying their bill, will include administrative fees just trying to collect, and losses when they cannot collect. The payment from Medicaid for seniors or welfare for under 65 is woefully low. Many ERs are closing, hospitals are closing and as a result the crowding in existing ERs becomes overwhelming to staff and patient alike.
I pay $9,000 a year for health insurance for just myself, since I must stay with a group retiree plan in order to get insurance. I can assure you the only time I go to the ER is in dire emergency, and I do not have a deductible. “May” encourage hypochondria? That is a loose statement.
How about the elderly population that are crowding our emergency rooms and health care facilities because medical research forgot to factor in quality of life?
LMc
In my place of work, the largest abusers of the ER are the medicaid patient. This is essentially single payer insurance at its worse. With decreasing payouts to primary care providers and ER’s shutting their doors, the ED crowding issue will only get worse.
I work with welfare-to-work clients. If a person is on welfare (cash assistance) or they are getting medical assistance only, they are getting a medical card and do not need to pay for medical services anywhere. I have seen my clients get braces and gastric bypass surgery. All paid for by us- the hardworking taxpayers!! God Bless America!!!