There are many arguments to make in regards to the benefits accrued by insuring more Americans. One of the anticipated benefits is to decrease the use of emergency room services by the uninsured, who often do not have a primary care physician. A recent study published in ” Science” magazine by Taubman (no relation) and others studied the effect of expanded government – sponsored health insurance in Oregon on emergency room usage. What they found was just the opposite. Newly insured patients used the emergency room 40% more than their uninsured counterparts. The increase in visits was across a broad range of conditions, and the vast majority of the increased visits could have been treated in lower cost primary care physician offices. An accompanying editorial states, “It is possible to argue that this represents greater access to necessary care, or that it shows that insurance serves as further encouragement to seek unnecessarily expensive treatment……Based on this paper’s findings, we have a good reason to anticipate a large increase – and almost surely not a decrease – in traffic to already overburdened emergency departments across the country.”
The reasons for the observed increases in ER use are likely many. One reason may be that patients are just doing what they were told; many busy primary care practices who already have schedules filled with non-emergent cases may tell patients to go to the emergency room so as not to disrupt their schedules. In addition more and more primary care practices employ physician extenders such as nurse practitioners and physician assistants who do not have the training or experience that allows them to comfortably see and treat sicker patients in an office setting. By contrast, in our unique practice model we always keep slots open for sick visits and whenever possible attend to people the same day. Finally, many hospitals (for profit and non- profit) incessantly advertise that patients should come and utilize their emergency rooms by instilling fear that a routine flu might be something more serious. While this may be good for the hospital’s bottom line, that calculus may be changing in Maryland (see previous post on Maryland Medicare Waiver).
Regardless of the causes, the health care system has to deal with the consequences. Warns the editorial, “Whether or not you think universal coverage is a good idea, we had better start planning for it.”