24 April 2009

Dog bites man

ER visits, costs in Mass. climb - The Boston Globe
More people are seeking care in hospital emergency rooms, and the cost of caring for ER patients has soared 17 percent over two years, despite efforts to direct patients with nonurgent problems to primary care doctors instead, according to new state data.
Hmmm.  Isn't this exactly what I wrote a few days ago? And tweeted?

ER congestion is as much due to the insured as the uninsured, and provision of universal health insurance will probably do little to alleviate the overcrowding.  In order to abate the ER crisis, there will need to be:

Either fundamental restructuring of Primary Care reimbursement to create the capacity for caring for all these low-acuity patients in the ER (which will take many years) OR a massive expansion of ERs nationwide to accommodate the volumes.

AND new rules & practices and inpatient capacity to end the practice of inpatient boarding in the ER.


  1. No, actually, Medicaideurs use the ER far more than everyone else. I don't consider them "insured". The privately insured use the ER the least when compared to the uninsured and those on Medicare.

    If you give everyone govt insurance, yes, they will flood the ERs as was seen in Massachusetts. Many people just don't have enough brains and responsibility to make and keep an outpatient appt. Failed appointments + Medicaid is a known phenomenon.

    If you're going to give away "free" health care, there needs to be co-pays for emergency services equal to at least the cost of one month's smokes or one month's cell phone bill. The co-pay should be paid prior to treatment for a non=emergency condition after the medical screening exam shows the presence of no emergency condition.

  2. K,

    You're half right -- which is pretty good for you -- in that yes, Medicaid patients do significantly over-use the ER. But study after study has also found that also over-represented, and largely responsible for the growth in volume, and the less-urgent cases, is patients with private insurance who usually get their care at a primary care doctor's office.

  3. Well if Medicaideurs (or whatever they want to call the "free" govt insurance hand-out du jour) are clogging up the ER with their new "insurance" en masse, I'm GUESSING that the privately insured will stay away for non-urgent stuff.

    Do you really think that everyone with private insurance in Massachusetts suddenly decided to start flocking to the ER just because they wanted to be like the "where's my free medical" crowd? No, probably not.


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