An onslaught of patients lacking health insurance may not be what's leading to congestion in hospital emergency rooms.
A solid majority of adults who use the emergency department four or more times a year do so with an insurance card in their wallet and a primary-care physician in their Rolodex, according to a recent study released last week by the American College of Emergency Physicians. The study shows that 84% of individuals who come through the ER are insured and about 81% have a primary source of care.
But those same patients also tend to be sicker, are veterans of many different hospital units and are generally disgruntled by the level of care they receive, according to the study.
The numbers appear to rebut the perception that ERs are clogged by the uninsured and those without routine medical care. The study's authors said the data can be used as a first step in finding ways to reduce ER utilization.
Regardless of the reason, emergency rooms are a significant source of healthcare spending, according to separate data released last week. Nearly 31 million adults, or 14.1% of the population, visited a hospital emergency department in 2003 at a total cost to private insurers, the federal government and the patients themselves of $29.3 billion, according to the Agency for Healthcare Research and Quality.
The ACEP results, however, come as little surprise to some doctors who work in emergency rooms. Peter Semczuk, vice president of clinical services at Montefiore Medical Center, New York, said the study jibes with what he sees across Montefiore's ERs, adding that close to 97% of adults who check in through the department are insured or at a minimum, insurable. Indeed, roughly $2 of every $10 spent on ambulatory care went to pay for ER visits at Montefiore, he said.
Semczuk said the problems in emergency rooms are rooted in years of health policy and practice that seemed good on paper but went awry in practice. In the 1990s, for instance, the growth of managed care was touted as a way to lower ER utilization, he said. But at the same time, physicians in outside practices started to work more routine hours -- 9 to 5 on weekdays -- and kept fewer and fewer weekend hours. Combined, the two trends greatly limited patients' access to care, often leaving the ER as the only option.
The ACEP study was conducted by the Robert Wood Johnson Foundation and the University of California at San Francisco, and used data culled from ER visits in 2000 and 2001.