Wednesday, March 17, 2010

ObamaCanard #93: Uninsured Folks Who Use Emergency Rooms for Primary Care Drive Up Costs for Everyone

How often have you read news reports like this one in the San Francisco Chronicle?

Hospital emergency departments, typically the medical providers of last resort, are becoming the only option for insured as well as uninsured people who are unable to get care elsewhere, leading to a record rise in emergency room visits over the past decade, a federal government report found...

"The uninsured have long been more frequent users of (emergency rooms). That's not new. What's new is the rise ... in frequency in visits, and that's occurring in the insured," said Dr. Stephen Pitts, author of the report and a CDC fellow who teaches emergency medicine at Emory University's School of Medicine.

Problem is, the meme is complete bunk.

As Robert J. Samuelson, writing in The Washington Post, and The New York Times' Freakonomics Blog report:

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." If universal coverage makes appointments harder to get, emergency-room use may increase.


...a new Slate article from Zachary Meisel and Jesse Pines offers a rosier picture of emergency room usage, and dispels several pervasive myths. They write that E.R. care represents less than 3 percent of healthcare spending, only 12 percent of E.R. visits are non-urgent, and the majority of E.R. patients are insured U.S. citizens, not uninsured, illegal immigrants. Meisel and Pines also point out that E.R. visits don’t necessarily cost more than primary care visits: “In fact, the marginal cost of treating less acute patients in the ER is lower than paying off-hours primary care doctors, as ERs are already open 24/7 to handle life-threatening emergencies.” Ultimately, Meisel and Pines believe that emergency rooms are functioning as they’re supposed to, as “an always-available resource to alleviate pain, make sure your baby is not truly ill, and patch you up after a nasty fall is vital, even if it turns out that your condition wasn’t as serious as you feared.”

Put simply, E.R.'s are functioning far better in the U.S. than in any other country.

Which is why Alan Grayson wants to destroy them. And, it would seem, kill you in the process.

In fact, the reason E.R. usage has grown is because of government-run health care. Most studies indicate that the difficulty in getting primary care appointments (especially for Medicare and Medicaid patients) has contributed to the rise in E.R. use.

So, if Democrats get their way with state-run health care for everyone, look for Emergency Rooms to resemble a DMV chock full of sick people.


The Ghost said...

just wait until the old uninsured have to go cross town to the only hospital that accepts their exchange traded health inscurance. I'm sure they won't just go to the nearest ER LIKE THEY HAVE FOR last several years.

The_Bad said...

Another reason for ER visits galore: lack of tort reform. Fear of lawsuit prevents doctors and nurses from advising you of anything without a formal appointment. Any question you pose to your doctor via telephone is met with direction to go to the ER, thereby avoiding any possibility of a lawsuit.

Anonymous said...

I'm an ER physician, and we're continually seeing upticks in our visit numbers. Today, we were swamped to the point of insanity. We did the best we could under the circumstances, and the sickest were seen ASAP; we have excellent triage nurses who do a great job, and we try our best to work quickly yet do a good job.

But we're hard pressed to take care of the load of folks who can't get into see their docs, who can't get appointments for months with subspecialists, and subspecialists are often not even in the area, driven out by the high cost of malpractice insurance (I'm in a state that just had caps on malpractice cases deemed "unconstitutional" by its Supreme Court. It's a state that is in the two two or three for corruption and being broke! Oh, and yes, the caps helped stem the exodus of practitioners from our area. That will again change and we will lose our good docs and subspecialists to the adjoining states that have limits on awards).

There is no question that the disconnect between what people think ER costs and what they actually pay, makes for a higher demand on our services. In addition to the truly sick, we see a lot of folks who pay nothing (Medicaid) come in for pregnancy tests, drug refills, care of sexually-transmitted disease (I'm sorry, you can't catch VD from the toilet seat, but you can catch TB from someone sitting next to you on a bus. The first should not be a public health crisis that is paid for by Federal Funds, and we will never eradicate it. I'm not a prude and was young once myself, but why a young person can't be charged a few dollars, at least, to share in the responsibility for treatment for their own behavior is a pet peeve...and we spend gobs on this).

But low co-pays for insureds predispose people to come in for things that common sense would go a long way towards taking care of: A minor foot sprain. A bruise on the ass. Paper cuts. Mosquito bites. Yes, we've had seemingly normal people come asking to have stitches for paper cuts (true story). And heaven forbid that someone would think to put an ice bag on a minor sprain and see if it gets better in a day or so. No, we call an ambulance, which can't turn away the patient for this (tying it up while someone has a real heart attack),in my state, and rush to the ER. Why? "Just in case".

I'm not advocating that people take chances on life-threatening illnesses. I'm talking about things our parents wouldn't have thought to go to an ER or ANY doctor. This IS costing us billions.

We were talking about this tonight, a fellow doctor and I; we looked around and both said "we're screwed". There is no way the current system is sustainable...and of course, Obamacare, as it's prototype Romneycare has shown, in Massachusetts, will only hasten the demise of decent health care in America.

Nahanni said...

What’s the Canadian word for ‘lousy care’?

Some say America should follow Canada’s lead, where private care is effectively banned. But having experienced their procedures while on holiday in Quebec, I really don’t think that’s a good idea at all.

A friend’s 13-year-old son tripped while climbing off a speedboat and ripped his leg open. Things started well. The ambulance arrived promptly, the wound was bandaged and off he went in a big, exciting van.

Now, we are all used to a bit of a wait at the hospital. God knows, I’ve spent enough time in accident and emergency at Oxford’s John Radcliffe over the years, sitting with my sobbing children in a room full of people with swords in their eyes and their feet on back to front. But nothing can prepare you for the yawning chasm of time that passes in Canada before the healthcare system actually does any healthcare.

Read the whole thing.