Elderly and middle class abusing emergency room services driving up cost of health care
Common wisdom is that Emergency room abuse is rampant among poor people and undocumented immigrants without health insurance. Turns out this is classist and racist and not true. Emergency room abuse is more common among elderly and middle class people who have long waits to see their physicians or specialisits.
Penelope Lemov has an interesting article in the September, 2006 issue of Governing magazine outlining this finding.
Researchers looked at patient traffic in emergency rooms in 60 communities all around the country and found that ER use was relatively low in communities with higher numbers of uninsured, Hispanics or non-citizens. Instead, use was high in places with more elderly residents and patients who have to wait a long time for appointments with their own doctors, and places where a smaller percentage of the population is enrolled in HMOs. “Emergency room use is up across the population,” says Peter J. Cunningham, the report’s author, “including more middle-class folks with private insurance.”
According to the study, the average use of emergency rooms is 32 visits per 100 residents. But Orange County, California, with its substantial numbers of both uninsured residents and immigrants, had the lowest ER usage rate at 21 visits per 100. The same held true for Phoenix and Miami-Dade — low usage but high uninsured and immigrant rates. By contrast, Cleveland, with low numbers of uninsured and relatively low levels of immigrant residents, had a high of 40 visits per 100 residents. Ditto for Boston.
As for Medicaid patients, they were not a factor in overuse of emergency rooms when they had access to HMOs. With managed care — at least managed care that works well — patients are part of a system that provides preventive
care and regular access to care.
So it turns out that those at the lower end of the income charts are not the ones clogging up emergency departments. Instead, the report found, it’s a very different population — older, middle class and unable to gain access to care when they need it. While these patients and their insurance companies pay the bill for ER visits, that’s still money being spent on an expensive — and often unnecessary — form of care. And this, in turn, affects health insurance premiums and the cost of health coverage to employers (which includes, of course, states and localities) — an issue that is becoming politically toxic.
Addressing the financial drain and overcrowding that defines the emergency room dilemma includes the problems of the uninsured poor — they often appear in the ER when their health is so compromised that they require more extensive and expensive treatment that they can’t afford to pay for. Their needs can’t be underestimated. But a solution must also include the issue of access problems at the higher end of the scale. Overcrowding in emergency rooms is becoming a crisis — visits increased by 26 percent between 1993 and 2003 and have been climbing since then — but the dilemma is, notes Cunningham, “a manifestation of a much more systemic problem.”
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