Health reform will increase ER use:
The E.R. Myth [Ramesh Ponnuru]
Robert Samuelson:
The uninsured, it's said, use emergency rooms for primary care. That's expensive and ineffective. Once they're insured, they'll have regular doctors. Care will improve; costs will decline. Everyone wins. Great argument. Unfortunately, it's untrue.
A study by the Robert Wood Johnson Foundation found that the insured accounted for 83 percent of emergency-room visits, reflecting their share of the population. After Massachusetts adopted universal insurance, emergency-room use remained higher than the national average, an Urban Institute study found. More than two-fifths of visits represented non-emergencies. Of those, a majority of adult respondents to a survey said it was "more convenient" to go to the emergency room or they couldn't "get [a doctor's] appointment as soon as needed." If universal coverage makes appointments harder to get, emergency-room use may increase.
[Great, pass reform on a promise to lower expensive ER care and end up increasing it. Unintended consequences are par for the course for liberal programs. ]
Samuelson goes on to question whether extending health insurance to the uninsured would really do much to improve their health. I share his skepticism, but it's worth pointing out that a desire to improve health outcomes isn't the only reason to wish more people had insurance: Lack of health insurance creates a lot of financial anxiety for a lot of people. That's a good reason for reforms that would make insurance more affordable even if those reforms would not do much to improve health.
corner.nationalreview.com
Another myth:
Non-citizen residents of the United States use the ED at a rate that is much lower than the national average.
rwjf.org
More:
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Some patients indicate a preference for ED care due to convenience, the access it provides to specialty care, or perceptions that higher-quality care is available in a hospital setting. Analysis of patient focus groups across the United States suggests a number of reasons why patients may prefer to receive primary care from an ED instead of a doctor’s office or health center (135). In many neighborhoods, the hospital ED is perceived as a provider of advanced, high-quality medical care and is known for its requirement to serve all patients regardless of ability to pay. Some patients find the ED convenient, since appointments are not required and it is always open.
Patient perceptions of the urgency of ED visits often differ from the judgments of clinicians and researchers. Moreover, these perceptions are often complex and uncertain, creating a demand for rapid confirmation and reassurance. A study of patients in the waiting area of an urban teaching hospital found that 82 percent of patients classified by triage nurses as non-urgent believed to the contrary that their condition was urgent (56). A limitation of the study is that patients may have exaggerated their condition to receive quicker attention (despite efforts by the researchers to limit this). In the “24 Hours in the ED Study,” the chief complaints of patients classified by triage nurses as non-urgent did not differ from the complaints of patients classified as urgent (166). Moreover, 5.5 percent of patients triaged as non-urgent were later admitted as inpatients, suggesting that even clinicians might underestimate the medical needs of ED patients upon first presentation. Patients often come to the ED for a variety of complex and overlapping concerns that are ultimately judged by clinicians as non-urgent (63). Concerns include the need to quickly relieve pain or discomfort and “making sure everything is OK.” Caretakers of young children express additional concerns. Some feel they need professional reassurance to deal with their child’s inability to express pain and other symptoms precisely. Others want to make sure they are not to blame for the child’s problem. Some describe their choice to seek immediate verification of non-urgency as a form of parental responsibility.
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Expansion of health insurance coverage on its own is likely to increase rather than decrease stress on overcrowded EDs.
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