October, 1996
A study by Harvard researchers and leaders of Physicians for a National Health Program published in this month’s American Journal of Public Health punctures the myth that costly emergency room visits by uninsured patients are driving health costs. President Clinton and other policy leaders have spotlighted ER overuse as a major concern, and managed care plans often deny coverage for ER visits as a cost-saving measure. The study found that uninsured patients use no more emergency care than insured people, and often pay out-of-pocket for their ER visits.
The study, based on data from the 1987 National Medical Expenditure Survey, found:
ER care for the uninsured totaled only $1.1 billion, or 0.23% of all health care costs; the entire ER bill for all Americans amounted to 1.9% of all health spending.
The uninsured averaged $37 per capita per year in ER care, vs. $38 for those with insurance.
The uninsured paid 47% of their ER costs themselves; only 10% was free care that hospitals cost-shifted to other patients.
While the uninsured got no more ER care than insured Americans, they got much less of other kinds of care. Hence, restricting ER access would take away a critical health care resource for the uninsured.
Children and black men also received much of their care from ERs.
Study author Patrick H. Tyrance, Jr., a senior student at Harvard Medical School and Kennedy School of Government commented: “Too often, minorities, the poor and the uninsured are blamed for high health care costs. Restricting ER visits will save little money, but will cut the care of people who need it most. We need to minimize ER care by making other care available, not by penalizing patients.”
Dr. Steffie Woolhandler, Associate Professor of Medicine at Harvard and study co-author said: “HMOs often refuse to pay ER bills, which shifts costs to the patients and increases HMO profits. Policymakers want us to believe that we must curtail further care to bring down costs. But compared to Canadians we pay 40% more for care and get less: fewer ER visits, fewer doctor visits, shorter hospital stays, even fewer high tech procedures like lung transplants.”
Dr. Woolhandler is a co-founder and spokesperson for Physicians for a National Health Program, a 7,000 member organization that supports universal access to health care under a single payer national health insurance program. PNHP has 59 state and local chapters.