Insured a big drain on emergency rooms ?!?

Medpundit commented on this, and it seemed too good to be true. The original article seems to have been written from an alternate dimension: | Business | Insured a big drain on emergency rooms

People with insurance are increasingly using emergency rooms, even for non-urgent care, a new study found — perplexing experts who believed the uninsured were the chief reason for emergency room overcrowding.

Emergency room visits jumped to an average total of 107.7 million in 2001 and 2000, up 16.3 percent from 1996 and 1997. Most of the increase came from insured patients, according to the Center for Studying Health System Change, a Washington-based think tank.

Privately insured patients’ use of the emergency room rose 24.3 percent to 43.3 million visits over that six-year period. People covered by Medicare, the government insurance for the elderly, visited the ER 16 million times, a 10 percent increase. Visits by uninsured patients rose 10.3 percent to 18 million, while those by patients covered by Medicaid, the government program for the poor, were flat at 18.4 million.

Now, on what planet are patients with Insurance a “drain”? My ED actively works to get that exact demographic (people with insurance) to come to us for care.

I don’t think people come to any ED for the ‘glamor’, even the nicest I’ve been in wasn’t a place I’d spend time voluntarily.

The reason people come to ED’s is because we’re too good for our own good. We work in an embarrasingly resource-rich environment, able to get the vast majority of common tests done within a few hours, and come up with an answer, or at least exclude life threats.

It’s a convenience issue, all right. I wonder when CLIA (Clinical Laboratory Improvement Act) kicked in, and docs were basically put out of the office-lab business. (Read that page and see if you’d have a lab in your office. Docs aren’t kidding when they scream about excessive regulation).


  1. I guess it all depends on your perspective. I rant and rave at work when I see people with minor problems, I’d much rather take care of sick people. But my colleagues remind me that out in practice, those sniffles and rashes are quick change in our pockets. I guess I’d rather have insured who’ll we get reimbursed for coming in. But overall, I’d rather not have a waiting room overflowing in to the street with chest pain and strokes waiting for an hour to come in.

  2. R.G. Lacsamana says:

    While there may indeed be reasons for patients, whether insured or not, to flock to the ERs even for minor problems,I believe tolerating this practice distorts the primary reason for why the ERs are there to begin with. There is also no disputing the fact that this practice adds up to the costs of medical care.

    Primary care physicians, of which there are no shortages nowadays except in some rural areas, should be at the forefront of providing non-emergency care. Even where patients expect a quick resolution to their problems, requiring laboratory and radiology work, access to these ancillary services is not a problem nowadays, with the PCPs in the best position to take care of their own patients. Most ER physicians are better trained nowadays to take care of emergencies, but patients should have second thoughts about relying on them for their pimary care just because of “convenience.”

    Some insurance companies, particularly those in managed care, require stringent guidelines before patients get approval for their ER visits. This had met with stiff resistance from patients, but it is one sensible thing to do. ER visits can be mighty expensive, particularly those requiring mutliple testing like CT scans, and can only result in higher premiums for everybody. Most patients are not aware of this, feeling that their co-payments will take care of the rest.

    Do we have reasons to be concerned? Of course we do. Hospitals along with the medical community should get involved in educating the public about the main purpose of emergency room visits. Yes, I believe that ER visits by an increasing number of insured patients should be curbed, unless for legitimate reasons. I believe we have been too lenient in imposing rules based on the common good.

    After all, eschewing those rules benefits the hospitals’ coffers, right?

  3. William Bromberg says:

    I completely agree with R.G. Lacsamana — except for one problem. Lawyers. Who makes the decision that someone is not sick enough for the ED and sends them away? The triage nurse? If one person complaining of heartburn is sent away from the ED and drops dead of a heart attack the hospital is set up for a fantastic law suit (not to mention tons of bad PR). My hospital won’t take that responsibility and therefore turfs the liability to the ED doc who has to see the patient to rule out heart attack (or whatever). At that point you might as well prescibe the H2 blocker.