ER use by uninsured disproportionately high

Group reports 14% of state's population made 23% of visits

January 31, 2001|By M. William Salganik | M. William Salganik,SUN STAFF

Uninsured Marylanders use emergency rooms much more often than people covered by Medicare or commercial insurance, according to new figures from Maryland Citizens' Health Initiative, a group supporting universal health coverage.

Vincent DeMarco, executive director of the group, said the cost of care for the uninsured is passed along in hospital rates paid by others, so "we are all paying for the uninsured not being able to go to primary care providers."

According to data collected by the state Health Services Cost Review Commission and analyzed for the citizens' health initiative, the uninsured represented 14 percent of the state's population, but accounted for 23 percent of the emergency room visits from 1997 to 1999.

Bartlett Naylor of Capital Strategies Consulting, who did the data analysis, said it was not possible to tell from the data whether the uninsured were visiting emergency rooms inappropriately for routine care or whether they had more emergencies because they did not receive preventive services.

According to Naylor's report, commercially insured people represent 65 percent of the population, but made only 47 percent of the emergency room visits. Twelve percent of the population is covered by Medicare and accounted for 11 percent of the ER visits.

Medicaid enrollees, 8 percent of the population, made 13 percent of the ER visits -- a rate of use similar to that of the uninsured. Naylor said he thought the high rate of Medicaid use might be because the program covers disabled people, who require more care.

DeMarco said the numbers supported his belief that overuse of emergency rooms by the uninsured adds to medical costs. Before the analysis, he said, there was only "anecdotal evidence" to support his opinion.

Dr. Robert E. Roby, chief of emergency services for Maryland General Hospital, said his experience also shows that the uninsured use hospital emergency departments for routine care.

"There's no question that the ER, which started decades ago as the accident room, has become the de facto safety net," he said.

However, he added, emergency departments are also providing primary care, especially evenings and weekends, for many "well-insured working people," whose doctors don't have extended office hours.

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