Emergency Rooms Continue to Serve as Patients' Primary-care Provider
Some people blame the U.S. economy’s sluggish recovery; others blame the influx of immigrants of all statuses; and still others blame the increasing number of people who live below the poverty line, including those who are unemployed or underemployed. Whatever the cause, the effect is the same: People who have little or no insurance are using hospital emergency departments (EDs) as medical homes for nonemergency healthcare. And this change affects the way hospitals in the United States do business.
For years, uninsured patients have flooded hospital emergency departments
seeking relief for common earaches, chronic disease management, and other nonurgent health issues. Many of these patients feel they have no other place to go, and some have never gone anywhere else to receive healthcare. In a May 2012 report, The Centers for Disease Control and Prevention cited a National Health Interview Survey that found that almost 80 percent of adults who visited EDs over a 12-month period said they did so because of a lack of access to other healthcare providers. One possible reason for the insufficient availability of timely care could be shortages of primary-care physicians (PCPs) in some areas of the country, according to the U.S. Government Accountability Office (GAO). However, as these patients become serial ED visitors,
the sheer number of them could overwhelm some hospitals. And that possibility raises some legitimate concerns that patients with true emergencies may be left languishing in the waiting room of the ED behind someone with a sore throat and cough.
Another issue is cost. Some people balk at having to pay emergency department prices after receiving nonemergency care. Obviously, if people are poor and have either no job or a low-paying job, then they may have trouble paying their ED bills. Plus, Medicaid and other forms of public coverage pay only portions of these bills. That reality coupled with the increasing volume of patients involved has caused some facilities to devise strategies for managing serial ED visitors.
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