Uninsured crowding ERs lacks evidence

Despite common perceptions that uninsured adults are primarily responsible for overcrowding in emergency rooms (ERs) or are using ERs to seek treatment for minor illnesses, a recent study finds that these lack evidence.

Robert Wood Johnson Foundation Clinical Scholar Manya Newton, MD, the University of Michigan, and colleagues compared assumptions in the media and medical literature concerning uninsured patients in the ER with available data on ER visits. To conduct the analysis, researchers examined 127 journal articles and print news stories and identified common assumptions about uninsured ER patients. Among the six most-common assumptions, three were not supported by data and the remaining three were true for all patients, whether they were insured or uninsured.

Common beliefs that the uninsured use the ERs for non-urgent care, that they are the leading cause of ERs overcrowding or that they visit the ERs disproportionately compared with insured patients are not supported by data, said the study, which was published in the Journal of the American Medical Assn.

“This should further convince us that the lack of access to care has nothing to do with insurance status,” says Albert Fuchs, MD, who practices internal medicine in Beverly Hills, Calif. “ERs are overcrowded by insured and uninsured alike. Part of the reason is that primary care is increasingly unaffordable even for the insured.”

The trend is being magnified by an increasing shortage of primary doctors, Dr. Fuchs believes. “The solution will involve reviving excellent affordable primary care,” he says. “Primary care physicians who are not compensated by insurance companies and who work directly for our patients are leading the way.”