Medicaid strains US emergency rooms
The U.S. government’s Medicaid program for the poor may put more financial burden on overcrowded hospital emergency rooms than the nation’s 47 million uninsured, according to a study published on Thursday.
Researchers at the University of California San Francisco and Stanford University found that the uninsured patients paid 35 percent of their overall emergency room bills in 2004, versus 33 percent for Medicaid.
"What surprised us was that uninsured patients actually pay a higher proportion of their emergency department charges than Medicaid does,” said Renee Hsia, an emergency room doctor and researcher at UCSF who led the study.
“This runs counter to the widespread impression that the uninsured are universally poor payers,” said Hsia, who noted that the ranks of uninsured include healthy young people who are employed full-time.
After reviewing charges and payments for 43,128 emergency department visits in the United States from 1996 to 2004, the researchers found the proportion of paid emergency room charges fell to 42 percent from 57 percent.
Reimbursements from all sources, including government programs for the elderly and poor, private insurance and uninsured people, declined over time, according to the study, which appears on the Annals of Emergency Medicine Web site and is slated to run in an upcoming issue.
Medicaid and the uninsured consistently paid the lowest share of emergency room bills. Declines in the proportion of payments during the study period were sharper among patients with insurance.
“Emergency departments provide valuable services to a wide variety of patients and act in many cases as core safety net providers,” said Hsia.
“Declining reimbursement ratios will cut into the ability of emergency departments to recover their actual costs of providing care,” she said, adding that data suggests emergency room reimbursements have continued to decline since 2004.
FRAYING SAFETY NET
Financial woes have forced hundreds of emergency rooms around the country to close. As a result, emergency rooms are treating more people than ever and getting paid less to do it.
According to the Centers for Disease Control and Prevention, the number of hospital emergency departments fell 9 percent to 3,795 from 4,176 in the decade leading up to 2005. During that same period, the number of annual emergency room visits increased by nearly 20 percent to 115.3 million.
People on Medicaid—a $300 billion federal and state insurance program that covers 58 million adults and children who are poor or disabled—visit emergency rooms at the highest rate, according to the CDC.
They are followed by patients covered by the government’s Medicare program for the elderly, the uninsured, and finally, people who are privately insured.
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