TUESDAY, Aug. 10 (HealthDay News) -- Increasing numbers of
Americans, especially adults on Medicaid, are using hospital
emergency rooms for their health care, say researchers from the
University of California, San Francisco.
Using data from 1997 through 2007, the researchers found that
ERs are increasingly serving as "safety nets" in American health
care, because by law they must treat all patients regardless of
insurance or their ability to pay, the researchers say.
"There are alarming trends in emergency department visits," said lead researcher Dr. Ning Tang, an assistant clinical professor of medicine at the university.
"In 1999 adults with Medicaid visited the emergency department at a rate 3.5 times higher than the rate of adults with private insurance, and in 2007 adults with Medicaid visited the emergency department at a rate five times that of adults with private insurance," she said.
Many of these visits by Medicaid patients were for conditions
that could have been managed in a primary care clinic, Tang
The report is published in the Aug.11 issue of the
Journal of the American Medical Association.
To calculate how emergency departments were being used, Tang's
team reviewed data from the National Hospital Ambulatory Medical
The researchers classified emergency departments as "safety-net
facilities" if more than 30 percent of all visitors were on
Medicaid; if more than 30 percent of visits were by people without
health insurance; or if more than 40 percent of visits were by
Medicaid and uninsured patients.
The number of emergency departments designated as "safety net"
centers increased from 1,770 in 2000 to 2,489 in 2007, the
They found that during the time period studied, annual emergency
department visits went from about 94.9 million to 116.8 million, an
increase of 23 percent, which is almost twice what was expected
based on population growth, they said.
The biggest increase in ER visits was seen in people 18 to 44
years old and those 45 to 64.
But there could soon be a problem with demand and supply: At the
same time that ER visits mushroomed, the number of emergency
departments fell by 5 percent, the researchers noted.
Moreover, visits among people receiving Medicaid went from about
694 visits per 1,000 people to about 947 visits per 1,000 people,
while visits by adults with private insurance, no insurance or
Medicare remained stable, they found.
Because of increased volume, median wait time for treatment
increased from 22 to 33 minutes during the study period.
Strategies are needed to prevent further stressing of this
"safety-net" system, the authors added.
The findings suggest that access to primary care is a key
problem, Tang said. "Whether it's primary care physicians are not
accepting new patients with Medicaid or that there aren't enough
primary care physicians, we need to dig a little bit deeper," she
Whether health care reform will help isn't clear, Tang said.
With more people on Medicaid, the future is uncertain, she said.
Even increasing reimbursement for doctors may not solve the
problem, she added.
Tang's group also noted that the recession may make the problem
even worse. "One of the nation's most severe recessions started in
2008, and with record job losses in 2008 and 2009, an estimated
additional 5.8 million Americans became uninsured and an estimated
5.4 million enrolled in Medicaid and SCHIP [State Children's Health
Insurance Program]," they write.
Dr. Tamara R. Kuittinen, director of medical education in the
department of emergency medicine at Lenox Hill Hospital in New York
City, wasn't surprised by the findings. "It's what we experience on
a day-to-day basis," she said.
There is no single explanation for the increase in emergency
room visits, but rather a combination of factors, Kuittinen said.
Hospitals and emergency departments are closing around the country,
so naturally there is an increase in people using the remaining
emergency rooms, she noted.
More individuals are receiving Medicaid assistance, she said,
and many primary care doctors aren't taking on new Medicaid
patients because of low reimbursement. "It's a problem with the
system," she said.
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