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Who's packing ERs? Not the uninsured

RightinNYC said:
You must have missed this:



If you thought that was the case before today, then you're far more clairvoyant than I.
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Err, no, because it makes perfect sense. Having insurance does not make you more or less likely to get in a car wreck or come down with a serious illness.
 
MrVicchio said:
One study and you're all over that aren't you?

Forget all the past stuff, the Gov't says that's all hog wash!

They love you, they really really love you.
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Err, you seem to have taken a few steps internally that you didn't post. What on earth are you getting at?
 
I'm more surprised by this:

It also rejects some claims that people are using the emergency department for routine care -- just 10 percent of visits were for non-urgent causes.
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Than the rest. I'd like to know how they defined "urgent" causes, though.
 
Tucker Case said:
I'm more surprised by this:



Than the rest. I'd like to know how they defined "urgent" causes, though.
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That's the thing. The only times we've been to the ER was when we were directed to go there, by my insurance. I didn't consider most of those trips particularly "urgent," they were more about my HMO playing CYA.
 
Tucker Case said:
I'm more surprised by this:



Than the rest. I'd like to know how they defined "urgent" causes, though.
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Urgent cause, for some folk, is needing IV Morphine 'real bad'...:doh
 
Catz Part Deux said:
The survey's methodology does not take into account the ER frequent fliers who visit the ER on a regular basis, and do not have insurance. These folks make up a substantial percentage of the people served in an ER on an annual basis. It delivers a misleading conclusion. One in five Americans may very well visit an ER annually, but that statistic doesn't answer two more important questions.

First, what percentage of Americans visit an ER more frequentlythan once? And, what is the daily count of ER "customers" and a comparison of insured versus uninsured.

Hope that helps.
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This could very well be the case, but the parts of the study that I can find seem to say that's not really it.

ER visits by the uninsured were no more likely to be triaged as non-urgent than visits by privately insured patients or those with Medicaid coverage.
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Also somewhat surprisingly, this isn't the first study to touch on this (though it's the first one I've ever heard of).

Arguments for health-care reform: Uninsured in the emergency room? | The Economist

and

Don't blame the uninsured for emergency room visits | United Liberty | Free Market - Individual Liberty - Limited Government

The JAMA study also found that patients with public insurance, such as Medicaid and Medicare, are more likely to crowd into emergency rooms for minor complaints than are the uninsured. Only about 17 percent of E.R. visits in the United States in the last year studied were by uninsured patients, about the same as their share of the population.
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Given that, I think it's likely that the uninsured use the ER proportionately to everyone else, which comes as a surprise to me.

Deuce said:
Err, no, because it makes perfect sense. Having insurance does not make you more or less likely to get in a car wreck or come down with a serious illness.
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You've never heard the claim that ERs are flooded with uninsured patients who treat the ER as a primary care doctor, and that the way to fix that is to make sure that everyone has insurance? It was a very prominent argument in favor of the health care bill.

http://www.nytimes.com/2008/12/09/business/09emergency.html

As increasing numbers of the unemployed and uninsured turn to the nation’s emergency rooms as a medical last resort, doctors warn that the centers — many already overburdened — could have even more trouble handling the heart attacks, broken bones and other traumas that define their core mission.
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Docs fear reform will exacerbate ER overuse | Indianapolis Business Journal | IBJ.com

One of the most agreed-upon reasons for health care reform was the expensive overuse of the emergency room by uninsured patients.
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missypea said:
Yikes! I don't think that's a good idea at all. Too many people wouldn't heed the warning signs that often appear before a heart attack, stroke, etc.
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Thats because the signs and symptoms of a heart attack or stroke can often mimic the symptoms of less dangerous pathologies. Its not that people wouldn't heed the signs, its that the signs are often confusing in the first place.
 
Catz Part Deux said:
I've actually needed IV morphine "real bad" (gall bladder needed to be removed), and it felt pretty urgent to me.
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You obviously don't understand the inside joke, so give it up gal...:doh

Wonder what time of the month it might be for ya? ;)
 
the most prominent person on the planet who didn't know all this was president barack hussein obama

he STILL doesn't know

someone should tell him

too bad he doesn't read important threads like these

(he's probably too busy rushing off to iowa or apologizing to calderon and hu for arizona)
 
The Prof said:
the most prominent person on the planet who didn't know all this was president barack hussein obama

he STILL doesn't know

someone should tell him

too bad he doesn't read important threads like these

(he's probably too busy rushing off to iowa or apologizing to calderon and hu for arizona)
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That's nonsense.
 
RightinNYC said:
This is very surprising. How is it that nobody knew this until now?
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I'm not sure I understand what this story is claiming.

PUBLIC hospitals ARE filled with illegals and uninsured patients on medicaid or state run health program.

Privately run hospitals are filled with people who have insurance covered by that hospital. And medicaid patients depending on the location and hospital policy.

Private hospital emergency rooms don't have to treat non-emergency patients without insurance. And those that they do treat will be transfered to a public hospital when stable.

Is the story claiming that people with insurance are going to public hospitals and claiming they don't have insurance?

Also, it follows that if more people are insured than not, then more insured patients will show up to emergency rooms overall. But if you look at just public hospital emergency rooms, then I don't believe people with insurance are going to go there, wait all day, lie on an admin form, just to get some free antibiotics.
 
MyOwnDrum said:
You obviously don't understand the inside joke, so give it up gal...:doh

Wonder what time of the month it might be for ya? ;)
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If the inside joke was that awesome, perhaps more people would have gotten it.

At least I'm only bitchy for 2-3 days a month. Some people are stupid for all 30.
 
hazlnut said:
I'm not sure I understand what this story is claiming.

PUBLIC hospitals ARE filled with illegals and uninsured patients on medicaid or state run health program.

Privately run hospitals are filled with people who have insurance covered by that hospital. And medicaid patients depending on the location and hospital policy.

Private hospital emergency rooms don't have to treat non-emergency patients without insurance. And those that they do treat will be transfered to a public hospital when stable.

Is the story claiming that people with insurance are going to public hospitals and claiming they don't have insurance?

Also, it follows that if more people are insured than not, then more insured patients will show up to emergency rooms overall. But if you look at just public hospital emergency rooms, then I don't believe people with insurance are going to go there, wait all day, lie on an admin form, just to get some free antibiotics.
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It's got nothing to do with the distinction between private and public hospitals or whether or not people are lying about things.

An oft repeated claim is that uninsured people go to the emergency room every time they have something wrong with them, whereas people with insurance go to their primary care doctor. Because ER care is more expensive to the hospital than primary care visits, many people have argued that one way to reduce overall spending would be to reduce the number of uninsured, which would eliminate that abuse of the ER system.

This study (and the others that I just now read about) concluded that there are no significant differences between the way that the insured and uninsured use the ER. That's very relevant in determining how to improve the health care system.
 
I think the whole premise behind the uninsured use of ERs is that they use them as the primary source of medical care, coupled with the fact that ER care is a much more expensive system of medical care delivery, rather than seeing a physician at his office.

Studies show this to be true, as the following article points out.

As for the assumption that uninsured patients seek out primary care in the ED because they have nowhere else to go: It is true, the researchers said.

"The problems leading to this national decrease in access to primary care are complex, but substantial evidence exists that uninsured patients' access to sources of care other than the ED has decreased and that ED visits for conditions that could have been prevented with adequate primary care have increased," the researchers wrote.

[...]

Another assumption that is true: It is much more expensive to treat uninsured patients in the ED than in other settings such as a physician's office or an urgent care center.

Medical News: Conventional Wisdom on Uninsured Use of the ED Is Only Half True - in Emergency Medicine, Emergency Medicine from MedPage Today
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The problem is, who pays for uncompensated care, be it insurance or taxes?
 
he said that by insuring all these millions he'd be keeping em outta the er's which would be a big savings

it turns out that er costs actually go way up

the reason they do is primarily cuz there are so many insured and so few docs YOU CAN'T MAKE AN APPT

at least not without waiting MONTHS

hello
 
BWG said:
I think the whole premise behind the uninsured use of ERs is that they use them as the primary source of medical care, coupled with the fact that ER care is a much more expensive system of medical care delivery, rather than seeing a physician at his office.

Studies show this to be true, as the following article points out.
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If the insured and the uninsured have identical rates of ER use and percentages of ER visits that are not emergencies, then the uninsured are not actually using ERs for primary care in any significant numbers. In that case, whether 40m or 5m people are uninsured should have little impact on how much is spent on emergency room care.
 
RightinNYC said:
It's got nothing to do with the distinction between private and public hospitals or whether or not people are lying about things.

An oft repeated claim is that uninsured people go to the emergency room every time they have something wrong with them, whereas people with insurance go to their primary care doctor. Because ER care is more expensive to the hospital than primary care visits, many people have argued that one way to reduce overall spending would be to reduce the number of uninsured, which would eliminate that abuse of the ER system.

This study (and the others that I just now read about) concluded that there are no significant differences between the way that the insured and uninsured use the ER. That's very relevant in determining how to improve the health care system.
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Okay, I agree with that.

I've spent a lot of time in the emergency room with my son's football injuries and my mother who has advanced Alzheimer's and has had infections and pneumonia that typically goes with that.

We always have a co-pay and/or our insurance is billed.

The thing about Primary Care Doctors w/kids... When something is broken, you know they're going to send you for an x-ray. And if the Pediatrician doesn't open until 9am the next morning... You go to the Emergency and they send you right over for an x-ray. Also, when your son takes a big hit to the helmet, then wakes up early in the morning sick to his stomach and dizzy, you haul ass to emergency.

I'm trying to think of an instance where we went to emergency when it wasn't an emergency. Paramedics automatically transport my mother there because she's been unconscious or bleeding from a fall.

The article doesn't mention what are the types of non-emergency, non-urgent care that account for that 10%.
 
RightinNYC said:
If the insured and the uninsured have identical rates of ER use and percentages of ER visits that are not emergencies, then the uninsured are not actually using ERs for primary care in any significant numbers. In that case, whether 40m or 5m people are uninsured should have little impact on how much is spent on emergency room care.
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In this study the researchers examined 127 peer-reviewed studies or editorials published from 1950 through September 2008 that dealt with ED use by uninsured adults ages 18 to 65, excluding visits for psychiatric or dental care. Besides finding that uninsured patients seek out primary care in the ED because they have nowhere else to go, they also found that the percentage of uninsured patients who are evaluated in physicians' offices decreased by 37% between 1996 and 2001. So yes this review supports the uninsured using the high cost ER as a primary care giver.

Another useful statistic would be if the percentage of uninsured that used primary care facilities was the same as the one concerning ER usage or if it would roughly equal the percentage of the uninsured. I looked, but couldn't find anything but vague assumptions.


http://www.medpagetoday.com/EmergencyMedicine/EmergencyMedicine/11402

As I said in an earlier post the problem is uncompensated care. I know in health care discussions, before the bill passed, we talked about disproportionate share hospital payments.

In 2004, uncompensated care is estimated to be $40.7 billion.

[...]

The primary source of funding for uncompensated care is government dollars. Projected federal, state, and local spending available to pay for the care of the uninsured in 2004 is $34.6 billion—about 85% of the total uncompensated care bill.

Over two-thirds of government spending for uncompensated care comes from the federal government, most of which goes toward payments to hospitals in the form of disproportionate share hospital (DSH) payments—payments intended to offset losses hospitals incur when large shares of their patients are unable to pay their hospital bills.


http://http://www.kff.org/uninsured/upload/The-Cost-of-Care-for-the-Uninsured-What-Do-We-Spend-Who-Pays-and-What-Would-Full-Coverage-Add-to-Medical-Spending.pdf
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We already pay for the uninsured medical costs. Why not make them pay for their own care via medical insurance?
 
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RightinNYC said:
That's an easy answer, but even if we pretend that NIH research funding is entirely political, I don't think it really holds water. The Bush Administration had no interest in creating national health insurance, but everyone knew that the Democrats did. If it had wanted to head that off at the pass, it could have just funded this study during its time in office.

I think it's just that no one bothered to do the research until now, which is fairly troubling given its importance to our planned health care reform.
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Nice statistic.

But in the end it does not matter.

The ultimate questions is:

Does ObamaKare pass Constitutional muster?​

No it doesn't.

But what do the Dems care?

.
 
zimmer said:
The ultimate questions is:

Does ObamaKare pass Constitutional muster?​

No it doesn't.

.
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I'm sorry, but has there already been a case that went before SCOTUS?

Nope. I guess we'll keep watching for one.
 
SCOTUS = infallible. Must be nice to live in bizarro world where logical fallacies don't exist.
 
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