Study: Uninsured No More Likely To Use ER Than Insured

  1. 4 by mary brophy marcus, usa today


    a kiss gone awry isn't the typical route that lands a person in the emergency room, but that's just how maggie craytor ended up in the [color=#00529b]niversity of virginia medical center's emergency department in august.
    "she was running after her older brother luke to give him a kiss, and she fell and got a cut right underneath her eye," says her mother, allison. maggie, now 4, needed two stitches. her mother is glad the family had insurance to cover the costly emergency visit her pediatrician's office recommended.
    the craytors, a family of five with private health insurance, are just as likely to use the emergency room as people without insurance, according to a new report by the [color=#00529b]centers for disease control and prevention.



    http://www.usatoday.com/news/health/...ncy20_st_n.htm
  2. Visit  DoGoodThenGo profile page

    About DoGoodThenGo

    From 'La Pomme Grand - NY'; Joined Jul '09; Posts: 3,887; Likes: 4,833.

    22 Comments so far...

  3. Visit  VickyRN profile page
    5
    What do they mean by "insured?" If they include Medicaid in the mix as "insured," then that definitely skews the study in a big way. I work PT in an ER and see terrible abuses of Medicaid in this environment - anything from people coming in to get "colds" treated, to a twenty-something woman wanting a pregnancy test (says she can't afford the $2 to buy a pregnancy test at the drug store) to a father wanting his son's miniscule "razor bumps" on the scruff of his neck investigated (from a prior haircut). The abuses of Medicaid in the ER environment are almost legendary.
    Medic2RN, CoffeemateCNA, fungez, and 2 others like this.
  4. Visit  Junebugfairy profile page
    3
    i too wonder what they mean when they say 'uninsured' and 'insured', it makes a difference...

    "to a twenty-something woman wanting a pregnancy test (says she can't afford the $2 to buy a pregnancy test at the drug store)"

    don't tell me, that is because her ciggarettes cost almost 5-6$ a pack now.. it's all about priorities.

    shoot, planed parenthood gives free pregnancy tests! they are not open at midnight though.

    i wonder, do you think that perhaps there could be a way to stop women from coming to the er for a (only) pregnancy test? it's way too common, and incredibly wasteful.

    carolinapooh, VickyRN, and S.N. Visit like this.
  5. Visit  Altra profile page
    3
    They are probably including those who get medical assistance in the "insured" population, because this is a form of health insurance.

    The conclusion of the study refutes the often stated theory that goes something like this ... "ERs wouldn't be crowded if it wasn't for all the uninsured people who don't have any other immediate access to free health care."

    As this study demonstrates, abuse and misuse of emergency departments and the resultant critical overcrowding it produces comes from many sources, including those with "good" insurance whose definition of an emergency probably needs a little tweaking.
    talaxandra, S.N. Visit, and VickyRN like this.
  6. Visit  DoGoodThenGo profile page
    2
    Quote from Altra
    They are probably including those who get medical assistance in the "insured" population, because this is a form of health insurance.

    The conclusion of the study refutes the often stated theory that goes something like this ... "ERs wouldn't be crowded if it wasn't for all the uninsured people who don't have any other immediate access to free health care."

    As this study demonstrates, abuse and misuse of emergency departments and the resultant critical overcrowding it produces comes from many sources, including those with "good" insurance whose definition of an emergency probably needs a little tweaking.
    Leave us not place the blame totally on patients/persons showing up at the ER for "non-urgent' care. As the article clearly points out, many persons with not only insurance, but primary care doctors, are sent to the ER by those very same doctors. Or, simply out of fustration of not having whatever problem they've been complaining about to their doctor addressed, it finally reaches a point where the ER is the only viable option.

    Don't know about where many of you all live, but here in NYC, trying to see your doctor or any in general outside of office hours is darn near impossible. Especially from about Friday afternoon when everyone starts heading out to the "Hamptons" or "the country", or where ever they spend their weekends. In the winter it's Tuscany or South of France, or Saint Bart's , either way either a telephone answer recording or the doctor's service will tell patients to go to the ER if something "cannot wait". That last part is pretty subjective for a lay person.

    Also as the article points out, persons do see their doctor, and try to have him/her address a problem, or complaint, but they spend more time waiting to see the doctor, than with the person himself. In many cases the "drive through" exam is a few simple questions, a couple of "uh-huhs" and that is that. Doc leaves to move on to the next patient and tells you to contact this nurse if "you need anything else".
    Not_A_Hat_Person and lorazepam like this.
  7. Visit  VickyRN profile page
    1
    The only trouble with Medicaid abuse is the fact that we, the taxpayers, are footing the bill. For the fiscall year 2010-2011, North Carolina again faces an enormous budget shortfall. The # 1 expense in NC is public education - this is where the legislators are choosing to make deep cuts (laying off teachers, cutting or freezing salaries, increasing class sizes, etc.). The #2 expense is - you guessed it - Medicaid. Twenty percent of NC residents are enrolled in Medicaid. The federal government pays 61%, while the tax-paying citizens of NC pay the remaining 39%. Not a word, not a peep, from the General Assembly of streamlining this bloated and abused system. It would help enormously and cut down on the abuse if a small copay were charged when a Medicaid recipient uses the ER facility for something that is non-emergent.

    Oh, and under Obamacare, Medicaid will be expanded by 50%
    SmilingBluEyes likes this.
  8. Visit  Junebugfairy profile page
    0
    i live in nc. maybe something like a 20$ copay for all nonemergent visits. perhaps making a 1-2-3$ copay for rx drugs would help.
  9. Visit  VickyRN profile page
    1
    Quote from junebugfairy
    i live in nc. maybe something like a 20$ copay for all nonemergent visits. perhaps making a 1-2-3$ copay for rx drugs would help.
    they need to do something and fast. this abused system is bleeding us dry. we need to stop penalizing the kids in public school and look at other ways to save $$$$
    SmilingBluEyes likes this.
  10. Visit  S.N. Visit profile page
    2
    I'm new to home health and also see the abuse of medicaid. I have one particular patient that has all the latest technology (new cell phone-blackberry, flat screen t.v equiped with dish network, computer ) and is on Title 19!!! She uses the ER on a weekly basis to tx her chronic migraine H.A. & seeks demerol/ phenergan. She's had test after test, and it's revealed that she has HTN, Diabetes and is severely Obsese. Pt teaching is not effective. She E.R. shops every other week. It seems she never has complaint of HA during reg clinic hours. It's riducoulous! Its really hard to deal with a gov system user. Why should she get a free ride? Makes me mad.. Have other pt's like her......
    carolinapooh and VickyRN like this.
  11. Visit  carolinapooh profile page
    5
    I'm amazed that a pediatrician's office can't do simple stitches. Is there something here I don't know? I mean, a PA or an NP can stitch someone up if it's that simple and give you a scrip for an antibiotic.

    IMO, and I used to see this a lot when I was a civilian RN, the insurance companies are just as much to blame. I wonder if her insurance would have paid for her to be stitched in an MD's office. The reason I say this is I've seen some stupid, stupid rationales (or lack of, really) for insurance practices. I had a patient at Duke who needed Epogen shots. You can learn to give these to yourself. The drug's not cheap by any means. But her insurance company would NOT pay for this person to give herself the shot at home, BUT they would pay for a $250 clinic visit for an RN to give it to her. The company told her husband that if she went to the clinic, it would cost them $20. If she did it at home, they'd pay $5K - FOR THE SAME THING. AND to further muck up the waters, she'd already taken the drug before.

    Insurance companies send people home with a potentially lethal and very dangerous drug EVERY DAY and have for decades - a drug that you can walk into any pharmacy and buy OTC: insulin. But they won't pay for self-administration of Epo? REALLY????

    Someone else got the same answer from a DIFFERENT insurance company for shots of Neulasta. They could go to the clinic for $20 (and take time out of their lives and away from work and family to go all the way to the doctor in the process), or do it themselves for $7K.

    What is WRONG with this country?
    Not_A_Hat_Person, S.N. Visit, Altra, and 2 others like this.
  12. Visit  stephenfnielsen profile page
    4
    -How many times have we heard, "We need to pass universal heath care because all these uninsured folks are clogging up the ERs and causing us to go broke"?

    This data suggests that a better way to clean up our ERs would be to change the malpractice paradigms.
    SmilingBluEyes, S.N. Visit, VickyRN, and 1 other like this.
  13. Visit  TRAMA1RN profile page
    4
    I think what it boils down to is laziness. It is simply easier to go to the ER than wake up in the morning and call your family MD for an appointment and wait. It is also priority now for all ER's to put customer service first, this means order x-rays when it is already known that it will read negative. Give narcotics for back pain when the patient has not even attempted anything else, because "nothing helps". It is amazing how many times we give narcotics, and order unneccesary tests, because it is what the patient or parent's want.
    S.N. Visit, Altra, carolinapooh, and 1 other like this.
  14. Visit  HiHoCherry-O profile page
    2
    Ahh yes. . . the person who comes to the ED for a non life/limb threatening event and is sure to ask for cab vouchers, food, drinks, dressing supplies etc. And then demand x-rays/CTs/MRIs for complaints that do not necessitate those particular tests. Gotta love em! I had a patient tell me that she was unable to go to her primary provider because he refused to see her until she paid her bill (I think it was for around $20.00). Many of these same individuals also use the ambulance service as their personal taxi.

    One of the hospitals I worked for kept track of how frequently individuals came in for narcotics. The person would then be contacted, while in the ED, by one of our case managers who would present a letter explaining that, although we are happy to care for that individual, the ED will no longer provide narcotics. Basically it was a pain contract. Many of these individuals had been provided follow up information including a list of clinics and primary providers as well as pain clinic information during previous visits. This would cut down on the frequency of ED visits (at least within that hospital system) for a while. Of course it was always at the discretion of the provider seeing the patient to determine if pain meds were indicated since there are times when these individuals are really having pain that should be treated with narcotics.
    S.N. Visit and VickyRN like this.


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