Uninsured Not Responsible For Emergency Department Overcrowding, Study Find

Main Category: Health Insurance / Medical Insurance
Also Included In: Public Health
Article Date: 23 Oct 2008 - 11:00 PDT

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Insured patients represent the majority of the increased use of U.S. emergency departments over the past decade -- not the uninsured as is widely assumed, according to a study published Tuesday in the Journal of the American Medical Association, USA Today reports (Appleby, USA Today, 10/22). For the study, Manya Newton of University of Michigan and colleagues gathered news reports and 127 medical research papers about uninsured patients visiting EDs with available ED data (Steenhuysen, Reuters/Boston Globe, 10/22).

The study, which was supported by the Robert Wood Johnson Foundation, found that nearly one in five papers published between 1950 and 2008 included an assumption that uninsured patients contributed to ED overcrowding, and more than 20% of the papers made assumptions that the uninsured use EDs for non-emergency care.

The authors of the latest study found other reasons for ED overcrowding, including understaffed inpatient hospital wards, ED closures, a shortage of inpatient beds and a growing elderly population with chronic illnesses. According to the study, "On a national level, 75% of the increase in ED use over the last decade is attributable to increased use per person, mostly by insured patients. The remaining amount is predominately due to an increase in population size" (Straus, CQ HealthBeat, 10/21). However, the authors noted that patients without insurance still accounted for most of the visitors at hospital EDs located in areas with high uninsured rates (USA Today, 10/22).

The study also found that the most common group to seek care at EDs are Medicare and Medicaid beneficiaries. Newton said beneficiaries visit EDs because they cannot get timely appointments with their primary care physicians (Reuters/Boston Globe, 10/22). In addition, Newton said that research shows that uninsured patients are less likely to visit EDs for non-urgent care, in part because of the high costs associated with emergency care. Newton said, "There's a myth that the emergency department provides free care," adding, "Yes, we see anyone who shows up at the door, but when we see you, we will send you a bill. The uninsured don't want to pay thousands of dollars to come in for the sniffles" (USA Today, 10/22). Newton and her colleagues also noted, "Policies based on inaccurate or simplistic assumptions have the potential to worsen an emergency care system already in crisis and run the risk of further stigmatizing vulnerable populations."

Linda Laurence, president of the American College of Emergency Physicians, said she agreed with the study's findings, adding that assumptions that uninsured patient make use of EDs for non-emergency care "have been a huge barrier" in efforts to reform emergency care. She said, "The reason for emergency department overcrowding is the practice of inpatient boarding," citing practices where patients are kept in urgent care wards after they have been stabilized until they can be admitted in other parts of the hospitals. "We need to shore up our emergency departments, and trying to steer patients away for their non-urgent care does nothing to solve the problem," Laurence said (CQ HealthBeat, 10/21).

An abstract of the study is available online.

The latest JAMA is a theme issue about the health of the nation. The issue includes several commentaries about the U.S. health care system, including two by presidential nominees Sens. Barack Obama (D-Ill.) and John McCain (R-Ariz.).

NBC's "Nightly News" on Monday reported on the new JAMA study (Williams, "Nightly News," NBC, 10/21).

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