Crowded ER? Don’t blame the uninsured

This article was originally on a blog post platform and may be missing photos, graphics or links. See About archive blog posts.

Emergency rooms, known for chaos and life-saving heroics, have become just as well known for crowding and long waits.

Often, people without medical insurance are blamed. Because they don’t have regular medical care, they simply go to the ER when illness strikes -- or so the thinking goes. And so the thinking goes wrong.

The uninsured actually don’t account for more than their fair share of ER visits, finds a study published this week in the Journal of the American Medical Assn. Anyone who’s ever gotten a bill from an ER might understand why. The uninsured don’t have someone else to cover the cost of such a visit, which isn’t cheap by anyone’s standards.

Rather, people with insurance are more likely to turn up at the hospital for minor ailments, the report finds.


The researchers, led by University of Michigan doctors, reviewed 127 medical research papers on emergency care for uninsured patients, searching for unsupported statements -- and then trying to establish whether or not such statements could be backed up by data.

Often, they couldn’t.

Says first author Dr. Manya Newton in a news release:

‘The rise in ED [emergency department] use has much more to do with the aging of the population, the increase in chronic diseases, and the decrease in available primary care than with the uninsured. Policies based on false assumptions risk diverting energy and money from confronting the true drivers of emergency department crowding.’

As the blog Pure Pedantry notes:

‘This article is a compelling evidence for the idea that insurance coverage and health care access -- while similar -- are not the same thing. You cannot simply will access into existence by providing everyone with insurance. Rather, I think the solution to ED crowding is that we need more -- many more -- primary care providers. Only an excess in the supply of primary care will bring the prices down and increase access for both the insured and uninsured public.’

With the ER situation growing more grim (ERs fail as the nation’s safety net), it’s a topic worth discussing further -- but with perhaps more facts than have been used thus far.

Observes the author of the Pure Pedantry post: ‘Whenever you are having a debate -- particularly a policy debate -- it is always important to check your premises.’

-- Tami Dennis