Health Insurance Underwriter

N O T E W O R T H Y

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Study: Uninsured Aren’t Responsible for Emergency Room Overcrowding

A study published in the Journal of the American Medical Association in October finds emergency room crowding is merely evidence of other problems plaguing the health care system.

The study, “Uninsured Adults Presenting to U.S. Emergency Departments: Assumptions vs. Data,” found that most emergency department overcrowding occurs because more patients from across the spectrum—not just the uninsured—are visiting emergency rooms than ever before and are being kept in the emergency room when they should be receiving treatment in the hospital or in a doctor’s office.

Although heavy concentrations of uninsured patients can bog down emergency rooms in some areas (such as inner cities), overcrowding happens across the country because of myriad flaws in the U.S. health care system.

The study also explored biases in scholarly writing about the uninsured.

After examining 127 medical research papers and several news reports, the study concluded one in five papers simply assumed the uninsured are the cause of the overcrowding, even absent evidence for it. Likewise, 20% of the papers assumed the uninsured use the emergency department by default for basic care even when a hospital or family doctor would suffice.

The past decade has seen more emergency room patients than ever before. Americans are living longer, leading to more chronically ill elderly, but there are fewer primary care physicians available to serve them and other patients. So patients turn to the emergency room when, in the past, they would have gone elsewhere.

Financial incentives, limited resources and other factors led to patients—ones who could be treated in other facilities—being boarded in emergency departments for several hours.

However, the unnecessary boarding of patients could create a national safety problem if an emergency happened and a large number of people needed emergency treatment, as too few beds would be free for incoming patients.

The full study is available at http://jama.
ama-assn.org/cgi/content/short/300/16/1914.

Entrepreneurial Care a Model for Entire System

Health care markets where patients pay directly create price and quality competition, according to a study by Devon Herrick, Ph.D., a senior fellow with the National Center for Policy Analysis.

The study, “Health Care Entrepreneurs: The Changing Nature of Providers,” cites cosmetic surgery as an example. Because procedures are rarely covered by insurance, patients pay out of pocket, thus, they are sensitive to price. This sensitivity causes them to compare costs and choose based on price and quality.

The study also cites LASIK vision correction because the procedure’s market has become very competitive. The competition is holding prices in check and improving quality in many ways, including accurate correction, faster healing, fewer side-effects and an expanded range of conditions that can be treated.

The prescription drug market is quickly becoming the best example of competition in the marketplace. The study notes that WalMart became the first national retailer to aggressively compete for buyers of generic drugs by charging a low, uniform price. Responses from other pharmacies include Giant Food stores’ offer to fill antibiotic scripts free of charge.

The study mentions the competition garnered from walk-in clinics in shopping malls and drug stores offering money and time savings. Electronic prescribing improves quality using error-reducing software. Medical tourism has also introduced new industry players.

The lack of competition results in a highly artificial market weighed down by high costs, poor or inconsistent quality, and inadequate access to care. It’s important we learn that a true health care marketplace built around competition rather than bureaucracy is what the system needs.