Uninsured not to blame for ER waits

Study contradicts a persistent assumption

By Julie Steenhuysen
Reuters / October 22, 2008
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CHICAGO - Contrary to conventional wisdom, hospital emergency departments in the United States are not overrun by uninsured people with minor ailments who want free treatment, US researchers said yesterday.

The findings, published in the Journal of the American Medical Association, contradict widespread assumptions that the nation's 46 million uninsured are to blame for long wait times and overcrowding in US hospital emergency departments.

"In spite of a common belief, the uninsured don't cause emergency department overcrowding. They are not showing up with non-urgent conditions. They are not overwhelming the emergency department," said Dr. Manya Newton of the University of Michigan, who led the study.

In a telephone interview, Newton said the assumptions persist despite a number of articles in the past decade suggesting the uninsured make up just over one-tenth of emergency department visits.

For the study, Newton and colleagues compared assumptions in the media and medical literature concerning uninsured patients in the emergency department with available data on emergency department visits.

Specifically, the researchers examined news reports and 127 published medical research papers, looking for evidence that the uninsured contribute to emergency department overcrowding.

"The uninsured are actually underrepresented in the emergency department. Seventeen percent of Americans are uninsured, almost one in five people. But in the emergency department, we see somewhere between 10 and 15 percent uninsured, closer to 10 percent," Newton said.

One reason for this, she said, is that unlike the insured, people with no insurance are billed for the full cost of the visit.

Newton said emergency departments are required to treat and stabilize anyone who shows up. "That doesn't mean we don't send bills," she said. "When they show up at the emergency department, instead of showing up with sniffles and backaches as is the common assumption, they are actually showing up far sicker than the average person because they delay care."

She said the most common group to visit the emergency department are the publicly insured - those covered under Medicare, the federal health insurance program for the elderly, and Medicaid, the federal insurance program for the poor.

Newton said both groups seek care in the emergency department because many people on Medicare and Medicaid simply cannot get appointments with their primary care doctors in a timely manner.

People in both programs are also more likely to need more care than others by virtue of their age in the case of Medicare, or disability, which often is a factor in qualifying for Medicaid.

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