Who’s packing ERs? Not the uninsured

http://us.mobile.reuters.com/mobile/m/AnyArticle/p.rdt?URL=http://www.reuters.com/article/idUSTRE64I78X20100520

“In 2007, approximately one in five persons in the U.S. population had one or more emergency department visits in a 12-month period,” the report from the National Center for Health Statistics reads.

“Among the under-65 population, the uninsured were no more likely than the insured to have had at least one emergency department visit in a 12-month period.”

Tamyra Carroll Garcia and colleagues at the center used two large national surveys of healthcare use in 2007 for their study.

“Since 1996, demand for emergency services in the United States has been rising,” they wrote.

“While the number of emergency departments (EDs) across the country has decreased, the number of ED visits has increased. As a result, EDs are experiencing higher patient volume and overcrowding, and patients seeking care are experiencing longer wait times,” they added.

Let’s see, population is rising, number of ED’s decreasing, seems pretty natural that service levels would decrease. No need to blame the poor or undocumented, simple economics explains the problem. Not that that will stop anyone. In times of uncertainty folks are always looking for someone to blame.

2 thoughts on “Who’s packing ERs? Not the uninsured

  1. Roy, the merits of your conclusions about illegal immigrants aside, the survey that article cites is an extremely weak indicator of their bona fide impact on emergency rooms. First, it relies heavily on face-to-face household interviews by civil servants and/or contractors that are collecting data for a government agency. It’s reasonable to assume the number of illegal immigrants interviewed was negligible if not nil so their impact on ERs wouldn’t be reflected in any meaningful manner. On another note, it simplifies the definitions of uninsured, (privately) insured, and Medicaid in a manner that inflates the “insured” category well beyond what many Americans would naturally assume qualifies. (For instance, it considers anyone with Medicaid and a supplemental private policy – which would include a large number of retirees – to be privately insured without considering whether that supplemental policy provides for primary care.) Likewise, it inflates the category of “uninsured” to encompass those who paid for their care themselves and/or had their care paid for by charity which, again, isn’t entirely consistent with what most Americans routinely envision when they think of “uninsured”.

    Furthermore, the other data source used was a survey of ambulatory care providers to ERs that a) didn’t collect a whole lot of demographic data aside from age and (presumably) race and b) doesn’t in any way reflect those who visit ERs under their own power or via some other means of transportation. I’d be curious to know how many illegal immigrants feel safe calling an ambulance for non-urgent care, though I suspect the number is low.

    Bottom line: you may very well be right in your conclusions about illegal immigrants but you can’t reasonably use this article or its supporting survey as compelling evidence one way or the other.

  2. “First, it relies heavily on face-to-face household interviews by civil servants and/or contractors that are collecting data for a government agency. It’s reasonable to assume the number of illegal immigrants interviewed was negligible if not nil so their impact on ERs wouldn’t be reflected in any meaningful manner.”

    Except that other information has shown they don’t use the same services at any higher level, and usually a lower one, than folks with similar socioeconomics backgrounds born in slightly higher lattitudes.

    The same reluctance to enter data on polls is encountered in exposing oneself to any and all government services, including healthcare. If going to the hospital increases the chance of being “exposed” you can bet it ain’t happening except in the most dire of circumstances. Hence the studies showing the undocumented having a neglible impact on health services with compared with the regular services used by the indigent.

    As far as inflation of categories, they are defining the categories and going with that. If you have to split it out into all possible scenarious, you get 15 categories and data mish-mash. Simply a decision having to do with the stats. I don’t see any real bias there.

    The point of the studies is actually just showing how often each of the defined groups visits an ER. That’s the important number. And with the number of ER’s going down, wait times go up.

    “Bottom line: you may very well be right in your conclusions about illegal immigrants but you can’t reasonably use this article or its supporting survey as compelling evidence one way or the other.”

    I think that was kinda my point.

    “Let’s see, population is rising, number of ED’s decreasing, seems pretty natural that service levels would decrease. No need to blame the poor or undocumented [for the percieved drop in services from “back in my day”], simple economics explains the problem. Not that that will stop anyone. ”

    Regardless, I’d be interested, perhaps another time, to hear of some of your experiences regarding the immigration issue. I know you are on the frontline on this one now.

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