Who Goes to the Emergency Room?

Patients at the Emergency Room


Let's see.  Tell me again why it's good for the uninsured to enroll in Medicaid and SCHIP?

Comments (6)

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  1. Ken says:

    Excellent point. We are enrolling people in Medicaid and SCHIP so they can get care in emergency rooms? Beam me up.

  2. Bruce says:

    If my back-of-the-envelope calculation serves, the percent of emergency room patients who have Medicaid or SCHIP is about twice their percentage of the population as a whole.

  3. Ron Greiner says:

    Parents that choose SCHIP for their children are gambling that their children won’t get sick or hurt. Millions of children have been terminated off their SCHIP insurance on their 19th birthday regardless of their medical history.

    My daughter was diagnosed with MS and the Rx is $30,000 per year. Lucky she wasn’t on SCHIP.

    When President Obama “sells” SCHIP insurance he should warn parents about the Termination Clause. Without a warning the President is committing a serious ethics violation. There is no warning on the SCHIP applications.


  4. Linda Gorman says:

    From the Urban Institute’s site which features an abstract of a paper written by Stephen Zuckerman and Yu-Chu Shen:

    The uninsured and the privately insured adults have the same risk of being frequent users, but publicly insured adults are 2.08 times more likely to be frequent users. Adults who made three or more visits to doctors are 5.05 times more likely to be frequent ED users than those who made no such visits. It seems hard to blame the overcrowding of EDs on the uninsured. Instead, the publicly insured are over-represented of among ED users. Frequent ED users do not appear to use the ED as a substitute for their primary care and, in fact, are a less healthy population who need and use more care overall. (Medical Care 42(2): 176–82, February 2004.) http://www.urban.org/publications/1000728.html

    Then there’s the Robert Wood Johnson Foundations “Urgent Matters” grant program. It has supported numerous studies casting doubt on the uninsured in the ER myth.

    Specifically, RWJF summarizes a paper by Weber et al. saying that

    “…the documented rise in ED visits between 1996 and 2004 cannot be primarily attributed to the uninsured. Instead, major contributors to the rise in number of visits are increased visits by non-poor people and people with other regular sources of care.” http://www.rwjf.org/pr/product.jsp?id=28272

    It summarizes a paper by Hunt et al. that also finds that the “lacking a usual source of care” argument does not hold:

    “… ● 81 percent of frequent users had a usual source of care and 84 percent had some form of health insurance. Adults who lacked a usual source of care were actually less likely to be frequent users.

    ● Poverty, poor mental health, poor physical health and having five or more outpatient visits were independently associated with the likelihood of frequent ED use. Medicaid enrollees and Medicare enrollees were also more likely to report frequent use of emergency departments.” http://www.rwjf.org/pr/product.jsp?id=15175

    In another summary, RWJF points out that the inconvenience of public programs might be a factor. Its write-up of Berry et al. says:

    “…Caregivers who chose to bring their children to the ED cited appointment delays, dissatisfaction with primary care providers, communication problems, convenience, and perceived ED quality of care and expertise with children.” http://www.rwjf.org/pr/product.jsp?id=37748

    The convenience factor was also cited for work done at Mount Sinai. The Robert Wood Johnson write-up for that says:

    “For most patients, [emergency room] utilization is not driven by lack of other affordable options, but rather by the scope, quality and availability of [emergency room] services as compared to other sources of health care.” http://www.rwjf.org/pr/product.jsp?id=16464

    Rather than blaming the uninsured, it might be more fruitful to think of the ER as the 7-11 of medical care—unlike the gatekeeper primary care providers that limit access in the Massachusetts public insurance program and in the Medicaid programs of other states, the ER is open 24/7 and it has everything in one place. For people with low opportunity costs for waiting and minimal copays, it is a relatively low cost place to get care.

  5. Jesse says:

    People need to get on medicaid and SCHIP so that hospitals/ERs are compensated for the care. Why are so many of the health care provider bloggers against insuring everyone?I don’t care whether we use tax money or we force people to spend their private money but everyone has to have health insurance. At least as long as EMTALA is around. And EMTALA isn’t going anywhere until the general public is okay with human road kill on the side of the road.

  6. Linda Gorman says:

    The majority of new SCHIP enrollees drop private coverage to enroll in SCHIP. This means that payments to physicians and hospitals fall because public reimbursement rates are below private reimbursements.

    Why should everyone have health insurance, especially coverage provided by government via the expensive SCHIP and Medicaid program? It arguably costs more to subsidize people who don’t want to buy health insurance it than it does to pay providers in the unlikely event that they run up big ones.

    Plus, private insurance is generally cheaper than the per capita cost of Medicaid or SCHIP.