Uninsured ER Fallacy

Robert Samuelson:

The uninsured, it’s said, use emergency rooms for primary care. That’s expensive and ineffective. Once they’re insured, they’ll have regular doctors. Care will improve; costs will decline. Everyone wins. Great argument. Unfortunately, it’s untrue.  A study by the Robert Wood Johnson Foundation found that the insured accounted for 83 percent of emergency-room visits, reflecting their share of the population. After Massachusetts adopted universal insurance, emergency-room use remained higher than the national average, an Urban Institute study found. More than two-fifths of visits represented non-emergencies. Of those, a majority of adult respondents to a survey said it was “more convenient” to go to the emergency room or they couldn’t “get [a doctor’s] appointment as soon as needed.” … Medicare’s introduction in 1966 produced no reduction in mortality; some studies of extensions of Medicaid for children didn’t find gains.

HT Tim Starr.

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  • jz-md

    1) True that many “insured” use the ED because of shrinking number of primary care docs/extenders.
    2) Does the data count Medicaid/equivalents as “insured”? Medicaid, in most states, is reimbursed almost nothing, so should count as a no pay.

  • jz-md

    Medicaid beneficiaries should count as “no pay”. Those single moms and their kids do use the ED disproportionately because no primary docs will accept them.

    • M

      So Angelina Jolie is a Medicaid beneficiary? Being a single mom doesn’t automatically qualify one for Medicaid. Many Medicaid “beneficiaries” are neither “single moms” nor “their kids,” so why single out those who are?

  • Jess Riedel

    After Massachusetts adopted universal insurance, emergency-room use remained higher than the national average, an Urban Institute study found.

    Use remained higher, but did it decrease?

  • I think the argument also includes the idea that under a health care plan where the currently uninsured have medical coverage, the costs of emergency room visit are no longer absorbed by the hospitals and can be passed on to the insurance company/the government. Costs would go down as hospitals no longer have to plan their budgets around people skipping out on the bill, and care would improve as hospitals don’t go bankrupt, or can utilize those funds in other areas.

    • Jess Riedel

      The only source of a surplus is the fact that treating non-emergent patients by appointment is cheaper than in the ER. Everything else is just pushing money around.

      For instance: if uninsured people are covered by the gov’t insead of relying on hospital ERs to cover their treatment, it is true that normal hospital bills will go down because the hospital won’t have to eat the cost of treating the uninsured. But since the gov’t is paying for the uninsured, the gov’t has to tax the insured. So on average, the insured still pay for the uninsured.

  • jz-md

    ER use in MA went up 9% after universal insurance.

  • Moreover, I am suspect about the “high-cost” of emergency rooms.

    If there is any part of the hospital that at least looks like its using resources efficiently its the emergency room. Now granted the emergency room has to deal with much more extensive cases than a simple child with a cough, but given what they are doing both the capital and the labor seem to be running at capacity.

    This does not appear to be the case in the rest of the hospital where one often sees huge, presumably very expensive, machines sitting idle and very expensive doctors engaged in idle banter.

    • Jess Riedel

      It is much cheaper to treat a given ailment in a normal doctor’s visit than the ER (assuming, of course, the ailment is not emergent). One factor is that when patients get appointment, doctors can line them up and treat them one-by-one. When patients come into the ER whenever the feel like it, there are surges and lulls so that doctors are used inefficiently.

  • Kakun

    AFAICT, the problem with hospital care for the uninsured is not that it’s less effective, it’s that it forces hospitals to give care without necessarily receiving anything in exchange. Too many public hospitals are now being forced to shut down- there are 300 fewer than there were 15 years ago. These hospitals often provide vital services lacking in the rest of the region- e.g. Grady Memorial Hospital, which is currently running a 53 million dollar defecit, has the only level 1 trauma center in north Georgia, Atlanta’s only emergency ambulance fleet, and important AIDS, dialysis, and sickle cell anemia units, beyond the 880,000 patients it serves each year. Preventing that would be the major improvement from universal healthcare.

  • lxm

    This week’s idea: Health care reform will not reduce ER usage
    Last weeks’s idea: Health insurance will not save lives
    The week before last’s idea: Health care reform will not reduce the deficit
    And before that: Health care reform will kill Grandma

    Maybe they are all true, maybe not. But maybe it doesn’t matter.

    What health care reform is about is whether this country will be governable or not.

    Something needs to happen that will force both parties to the table for real negotiations and real solutions to the serious problems this nation faces. Right now it looks like the Republicans are the villains, but, if push ever comes to shove, the Democrats will probably prove just as obstinate.

    I hope the Democrats pass the flawed health care bill. I hope that success will start to move the Republicans into a more productive opposition, rather than the burnt bridges path they are currently on.

    Our leaders have succeeded in making nothing work.

  • Shae

    I’m not sure if who goes to the emergency room more is the point. I think I’m more curious as to what percentage of emergency room visits by the uninsured are emergencies vs. what percentage of emergency room visits by the insured are emergencies.

    As others have implied, this would be interesting for a number of reasons: Are those uninsured skipping out on the (higher than a doctor’s office) bill more, are they getting worse care, paying more when they do pay, making the emergency room less efficient, etc.

    One notable point is that the uninsured using the emergency room instead of a doctor’s office may be because they have no choice, which keeps the poor poorer, while when the insured do so they do so out of choice (convenience).

  • Thomas Jefferson

    83% are insured? That sounds about right since the uninsured make up about 17%. But so what? That still amounts to billions of dollars in care that go uncompensated. But of course we are the ones who pick up the slack.

    Here is another figure for you. According to The American College of Emergency Physicians, “emergency physicians estimate that one out of every three patients they personally treat are uninsured. They say one-fourth of their uninsured patients are children under age 18”.

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