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Uninsured Don’t Jam Up the ED

Despite the popular notion that crowded emergency departments (EDs) are filled with the uninsured, a recent study in the Journal of the American Medical Association suggests that perception is unsupported. A literature review by Manya F. Newton, MD, MPH, a Robert Wood Johnson Clinical Scholar candidate at the University of Michigan, and colleagues spotlights assumptions that the uninsured use the ED for nonurgent or nonemergent care or primary care-type, that uninsured patients are a common cause of ED crowding, or that the uninsured are high users of the ED. They say these assumptions are not supported by current data.

The reviewers identified six common assumptions, which reflected “conventional wisdom” about uninsured patients in the ED, and found that three were not clearly supported and the remaining three were true for all patients — insured and uninsured alike.

Policies intended to address ED crowding by blocking or creating barriers to ED access for uninsured patients are unlikely to be effective because, according to the researchers, “little evidence exists that uninsured patients are a large proportion of the problem.”

Policies that redirect patients who require nonurgent care to primary care sources are unlikely to be successful unless those sites are readily accessible.

The researchers concluded that privately insured, publicly insured, and uninsured patients will continue to go to the ED if they are unable to find primary care physicians who accept new patients, if they are forced to wait weeks for an appointment, if they cannot obtain primary care because of its hours or location, or if they perceive care from other providers to be substandard compared with care received in the ED.

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