Study: EDs, strained by recession, at a breaking point

Everyone in the healthcare business knows that the emergency department system was already under tremendous pressure before the recession hit. Now, a new report from the Kaiser Family Foundation's Commission on Medicaid on the Uninsured is suggesting that for some hospitals, recessionary pressures may be the straw that breaks the camel's back.

ED capacity has been strained for some time, and nearly all EDs surveyed by Kaiser this time around reported that volume was rising. In addition to the usual pressures that fuel ED overcrowding, they're also facing additional problems, including more visits from both insured and uninsured patients with inadequate access to primary care, and an influx of insureds who can't afford their deductibles and out-of-pocket costs imposed in a primary-care setting.

Add that to the fact that few private practices accept the uninsured, sliding-fee clinics are backed up and community centers crammed to the gills, patients are left with few options. Many are forced to go there just to get a refill for their prescriptions for an ongoing condition, some doctors told Kaiser researchers.

On top of everything else, the patients that are seen at the ED are getting sicker. Since patients may not get primary care, they come to the ED repeatedly or later in the progression of their illness, a process which adds substantial costs to their care. Meanwhile, uninsured and even insured patients may be declining medically recommended care for cost reasons, a decision which, once again, puts them back in the ED in a sicker, and costlier-to-treat, state than they would have been in otherwise.

Ultimately, these and other issues arising from the influx of financially-strapped patients could be more than EDs can handle, especially if reform measures cut public funding for these services, Kaiser researchers say.

To learn more about the Kaiser study:
- read this report [1] (.pdf)

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