The number of uninsured has risen to over 50 million Americans or 16 percent of the population, according to newly released statistics from the U.S. Census Bureau – but what does that mean for emergency departments across the country?
Quite simply, we will be seeing more patients in the foreseeable future. While health care reforms move forward to address the millions of Americans without health insurance, that is only half of the problem. The other half is access to care, and there is ample evidence that even when everyone is insured, access to care will still be a problem.
As has been demonstrated in Massachusetts, merely having an insurance card does not mean access to care. ER volumes there have increased 7 percent since the state passed its own health care reform, despite better insurance coverage.
Problems related to access take many forms.
Many patients that are treated in ERs continue to be sent there by their primary care provider. Some are sent for very legitimate reasons, such as lower abdominal pain where the concern about appendicitis needs to be addressed urgently. Others are sent in for convenience’s sake; the office is closing, it’s Friday, or the office is just too booked to see you in the next 5 days.
Add to that the larger number of American covered by government programs Medicare (30.6%) and Medicaid (15.7%) where reimbursement rates cause many private physicians to limit or not accept these types of programs and yet more patients are “directed” to the ER for care.
Legislators and regulators continue to debate the high expense of emergency medicine and the need to reduce its overuse. And yet emergency medicine accounts for just 2 percent of total health care spending in this country (money which, I submit, with all its imperfections, is the best 2 percent we get for what is provided). Emergency medicine is still the “safety net” for health care, and its use will go up before it goes down.