Emergency Department crowding not due to medical indigence.
From the New York Times published on May 6th 2008 comes a report that emergency departments (ED) are busy but fewer patients seen in the ED are uninsured. Data was collected from a study in the Annals of Emergency Medicine (AEM) and published on line on the 14th of April 2008. The AEM study specifically looked at a rise in ED use over an eight year period from 1996 through 2004 to see if the rise in ED use was associated with insurance status. Their conclusions showed that while there was a rise in ED usage nationally during the study period it could not be solely attributed to medical indigence.
Furthermore they concluded that there was a disproportionate rise in ED use by “nonpoor” persons and by persons who typically obtained healthcare from a primary care physician’s office. Of note the study found that during the period in question the rise in ED usage increased 26 percent – 113.9 million ED visits total in 2003. Children were not included in the study sample and the authors of the study acknowledged that there may be an underrepresentation of homeless people in the sample.
Most interesting was the fact that several studies in the AEM report showed that those persons who are considered medically indigent had just as much likelihood to use an ED as more affluent and insured persons. Persons that were deemed to be frequent users of an ED for “inappropriate” reasons were evenly splint across the population and not just those that had little to no insurance.
Crowding in the nation’s EDs as the study points out is a multi-factorial problem that is attributed to such items as population increases, aging of the population, poor primary care provider access, and complications from medical and surgical procedures to name a few.
So what does this mean? In terms of legislation and policy change from both healthcare industry leaders and law makers, the solution to ED crowding does not appear to be within the confines of providing a health insurance for the population at large. Rather that access to primary care providers needs to be improved and the general quality of healthcare that is delivered needs to be improved. Furthermore a renewed focus on preventive care programs by healthcare leaders and providers should be established with reimbursement from insurance payers. In some poorly served areas local stand alone urgent care centers may need to be established that have ties to acute care organizations to improve access and mitigate wait times.
About the Author
Mike Pringle is the author of Healthcare Today where he offers commentary and insight regarding today’s healthcare issues. Additionally he provides regular commentary for Red Scrubs and editorial content for Future Healthcare. He has over 20 years of nursing experience working both domestically and internationally. Mike has a Bachelor’s Degree in Nursing and a Masters Degree in Public Administration with a Healthcare emphasis. He specializes in both Emergency and Critical Care Nursing. He currently works at Falmouth Hospital as a Shift Manager for the emergency department.
