The uninsured and the emergency rooms

By Kevin J. Price

Rarely would one expect to find anything interesting from an agency called the National Center for Health Statistics (NCHS), but a report on how emergency rooms are used and by types of groups is creating quite the stir among advocates of government health care and ammunition for opponents of socialized medicine. NCHS is the nation's primary health statistics agency and its new report suggests that the perception of our emergency rooms being dominated by the uninsured is based more on fiction and propaganda than on fact and reality.

The prominent use of the emergency room by the uninsured was one of the most frequently heard arguments for the President's socialized medicine program. Since people know they can get treatment there without paying immediately (if at all), they would fill up the room regardless of how small the need. The argument goes on that this care costs so much more and when done for non-emergency needs, it creates a disruption of care for those who really need emergency treatment. Devon M. Herrick, a health economist and senior fellow at the National Center for Policy Analysis, believes the data from the NCHS paints a very different picture.

So who are the biggest users, those most likely to misuse, and even abusers of emergency rooms? According to NCH,S it is a group that already has government health care...individuals in the Medicaid system. Here are some other findings:

· Approximately 32 percent of these Medicaid enrollees used the emergency room at least once during a 12 month period in 2007. Meanwhile, those with private health insurance were only about half as likely (17 percent) to go to an ER, and a similar number (around 20 percent) of the uninsured did the same in that time frame.

· Medicaid enrollees were three times more likely than those with private insurance and twice as likely as those who are uninsured to go to the ER twice in that past year.

· There are approximately 120 million ER visits made in the United States each year. These make up approximately 11 percent of all ambulatory visits.

One thing that there is little debate among health care professionals is that many of these 120 million ER visits could be better handled in other environments (such as a doctor's office, emergency clinics, etc.). Dr. Stephen Nichols, a regional medical officer for Schumacher Group, says "In general, 5 percent to 25 percent of patients who visit an emergency department in a community hospital have non-urgent complaints that could easily have been addressed in an outpatient setting," The Schumacher Group contracts for emergency department services at community hospitals.

The Heartland Institute in its report on the uninsured and their use of emergency rooms, quotes Dr. John Dunn, an emergency room specialist from Brownwood, Texas who noted that "Thirty percent to forty percent are emergencies or urgent care and deserve treatment within a reasonable time. But it is care that could be seen to in an urgent care clinic or a well-equipped office, though the patients probably are better off in the emergency department."

Why are Medicaid patients the most likely to use the ER in a less responsible manner? It simply comes down to the economic way of thinking. People with private insurance pay significantly more in co-pays for using an emergency room over a clinic or doctor's office. Therefore, avoiding the Emergency Room makes economic sense to them as consumers. Obamacare will essentially have all Americans treated similarly to the current Medicare patients. As a result, one can expect ER abuse to explode once socialized medicine goes fully into effect. This NCHS study not only weakens the argument for socialized medicine, but would be a devastating blow if facts still mattered in public policy debates.
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Kevin Price
Host, Price of Business, M-F at 11 am on CBS Radio News
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