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Medicaid and ER Overcrowding

August 13, 2010
9:53 am

We should be concerned about a report this week in the Journal of the American Medical Association (JAMA), which presents a picture of increased crowding in the nation’s hospital emergency rooms, with Medicaid patients making up the lion’s share of the rising demand for ER services.

According to JAMA:

•    The number of patients visiting emergency rooms rose from 95 million in 1997 to 117 million in 2007.   This 23 percent increase in a decade significantly exceeds what could have been reasonable expected based on population growth.

•    In 1999, there were almost 694 ER visits, on average, for every 1,000 Medicaid enrollees.  In 2007, there were over 947 visits for every 1,000 individuals on Medicaid.

•    The ER visit rate stayed relatively stable over that time period for Medicare patients, the privately insured and even the uninsured, telling us that Medicaid beneficiaries are driving the growth in emergency room traffic.

With Medicaid expansion playing such an important role in the implementation of health reform and the projected decline in the nation’s uninsured population, the JAMA study takes on great importance.  Because Medicaid pays such comparably low reimbursement rates to physicians, many doctors won’t see Medicaid patients.  This increase in patient traffic has caused ER wait times to jump by 50 percent during the 1997-2007 period examined in the study.

As the study’s authors wrote, it is a “critical concern” how emergency rooms are going to deal with the 16 million Americans who are expected to be added to Medicaid rolls once health reform is fully implemented.

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