A recent federal report casts more concern that hospital emergency rooms are having increasing difficulty treating all comers, especially because federal payments and the uninsured don't pay their full cost of care.
"There is a growing concern that EDs will not be able to sustain care for all persons in the current economic environment," according to the report, entitled "Payers of Emergency Department Care, 2006," that was published by the U.S. Agency for Healthcare Research and Quality.
"Between 1993 and 2003, there was a 23% increase in ED visits and a closure of 425 hospital EDs. In addition, a recent Institute of Medicine report notes that EDs have become increasingly overcrowded, overburdened, and underfunded. Yet little is known about who is paying for ED care, what the charges are for the care, and how to potentially relieve this pressure," the report said.
Of all visits to hospital emergency departments in 2006, 41.8% of the care was billed to the federal government–21.6% to Medicaid and 20.2% to Medicare. Another 17.7% were uninsured. An estimated 34.6% was billed to private insurance, and the rest to other private payers.
But those with no insurance were less likely to have medical problems so serious that their trip to the emergency room ended with an admission to the hospital, according to the report. Only 6.8% of the 21.2 million visits among the uninsured required an inpatient hospital stay; the rest were treated and released.
The report said the low percentage of patients with no insurance who went home without being admitted is "a possible indication of their use of hospital emergency departments as their usual source of care."
For those covered by Medicare, about 38% of the 24.2 million visits ended up with a hospital admission, compared with 11% of the 41.5 million visits billed to private insurers, and 9.5% of the 26 million visits billed to Medicaid.
All hospitals must at the very least provide medical screening exams to anyone who presents to an emergency room regardless of their ability to pay and must determine their need for further treatment for an illness or injury within 24 hours. However the law, called the Emergency Medical Treatment and Active Labor Act is not funded, and hospitals have long complained that their ability to continue providing such care is increasingly limited. Patients are arriving later in the course of their illnesses, and are often much sicker, they claim.
Among other highlights from the report:
- The rate of emergency department visits among the uninsured, 452.1 visits per 1,000 persons, was much higher than the rate among the insured, 367 visits per 1,000 persons.
- Relative to the population distribution in the U.S., Medicare was billed for more ED visits resulting in admission (50.3% compared to 13.5% of the population); Medicaid was billed for more treat-and-release ED visits (23.1% compared with 12.9% of the population) and private health insurance was billed for far fewer ED treatment and release visits and visits resulting in admission.