Uninsured not main reason for ER crowding

NEW YORK Tue Oct 21, 2008 3:03pm EDT

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NEW YORK (Reuters Health) - Contrary to what many believe, people without medical insurance are not the primary cause of the overcrowding that is typical in emergency rooms at US hospitals, new research indicates.

"There is a commonly held belief that uninsured patients abuse the emergency department, coming in for 'non-urgent' complaints, are overwhelming the system. This is simply not true," lead author Dr. Manya F. Newton told Reuters Health.

On the other hand, the assumption that increasing numbers of uninsured patients are being seen in ERs is, in fact, true, according to the report in the latest Journal of the American Medical Association.

Crowding in the ER is due to many things, including an increased amount of ER use by everyone, fewer emergency departments, and fewer inpatient beds, Newton explained. "People without insurance tend to use the emergency department less than any other group, and when they present they tend to be sicker."

Newton, a researcher with the University of Michigan, Ann Arbor, pointed out that this study is the first "to critically examine unsupported statements" about uninsured patients in the emergency department that appear in medical articles.

Newton's team identified 127 studies that looked at the medical and surgical care of uninsured adult patients in emergency settings. Assumptions identified in these studies were then tested against validated data.

Overall, 53 studies had one or more assumptions about uninsured ER patients, according to the report.

The assumptions that increasing numbers of uninsured patients are going to emergency departments and that uninsured patients lack access to primary care were both found to be accurate. Likewise, the belief that treatment in the emergency department is more expensive than office-based care for both uninsured and insured patients was also true.

Unsupported assumptions include the beliefs that uninsured patients are the main cause of emergency department overcrowding, that uninsured patients have less acute conditions than insured patients, and that uninsured patients use the ER mostly for convenience.

"We have a crisis in the emergency department and we have a crisis with the uninsured, but it is crucial that we do not assume that the latter is causing the former," Newton emphasized.

"If we attempt to solve emergency overcrowding by creating policies based on inaccurate assumptions, common knowledge, or what 'everybody knows,' we will waste limited resources, fail to address the root causes of the problem, and potentially increase the barriers to care faced by 47 million uninsured Americans," Newton concluded.

SOURCE: Journal of the American Medical Association, October 22/29, 2008.

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