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Common assumptions about uninsured ED users are false, says study

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Half of the six most common assumptions about emergency department use by uninsured patients are false, and what's more, the remaining three are supported by fact, but are equally true for both insured and uninsured patients, according to new research appearing in the Journal of the American Medical Association. 

Perhaps the most common assumption about uninsured patients--that they frequently come to the ED for non-urgent care--actually isn't supported by current research, according to study lead author Manya Newton, M.P.H., M.S. of the University of Michigan. According to her data, non-urgent visits by uninsured patients climbed from 11 percent to 16.7 percent from 1997 through 2005. However, that was just a bit larger increase than the four-percentage-point climb in such visits, the authors noted, citing the National Hospital Ambulatory Medical Care Survey.

Data suggests that uninsured patients are less likely to be admitted than those with insurance, but this could be because physicians have a higher threshold for admitting the uninsured, researchers suggest.

Another common assumption, that uninsured patients are to blame for ED overcrowding, is not clearly supported by existing data, researchers said. Of about 115 million annual ED visits, just 17 percent are made by uninsured patients. Since this is similar to the proportion of uninsured vs. insured patients overall, this suggests that neither group uses the ED disproportionately, the study concluded.

To learn more about common (and possibly inaccurate) assumptions about the uninsured in EDs:
- read this MedPageToday piece

Related Articles:
Study: OR Medicaid cuts push up ED visits
Newly-insured still use ED often in Massachusetts
Hospitals working to avoid non-emergency ED care
Report: ED visits climb 36 percent over decade

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The problem may be semantic. Hospitals may use the term 'uninsured' and be including the 'under-insured' - Medicaid, Medicare, Tricare. Under-insured in the sense that many facilities are unable to offset the costs of caring for these groups through cost shifting due to populations. If the population utilizing the facility services is 80% plus of these underinsured groups, lucrative contracts with traditional insurers are not prevalent enough to 'cost shift'. We need to look at real data at the individual and specific facility level in order to create accurate assessments of care utilization.

I am responsible to collect the hospital bills for our emergency room which is one of the top 10 in volume. 2005 data does not relect 2008 data..Between the years 2005 and 2008 the following has occurred:
1)most hospitals have instituted charity care policies that rival public hospitals..therefore if you come to an emergency room and fall below 400% of the poverty level you will have a minimal amount to pay..hospitals have been hit hard by citizen action groups,IRS and states to reduce their collection efforts..put these two together and the patients figure out i can get serviced and not pay my bill..
2)the federal government and states have made the enrollment process into a government program more difficult..more uninsured..

health care is changing as i write this..time to use current data

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