According to The Oregonian, "Cuts in the Oregon Health Plan led to 'an abrupt and sustained increase' in the uninsured using hospital emergency rooms, a new study reports."
From the report published in the Annals of Emergency Medicine, the paper pulled the following data on the effect of cutbacks in the Oregon Health Plan in early 2003:
- DOWN 52,000: Oregonians with health coverage
- UP 36 percent: Visits to hospital emergency rooms by uninsured patients
- UP 82 percent: Uninsured ER visits for alcohol use
- UP 106 percent: Uninsured ER visits for mental health problems
- UP 173 percent: Uninsured ER visits for drug problems
Of course, the high cost of seeing those patients in the emergency room is shifted to those of us who have some insurance.
The study concludes, "Oregon’s Medicaid cutbacks were followed by increases in emergency department use and hospitalizations by the uninsured. Recent federal legislation facilitating similar Medicaid changes in other states may lead to replication of these events elsewhere."
You can read the Oregonian story here.
The study is entitled Impact of Medicaid Cutbacks on Emergency Department Use: The Oregon Experience. You can download the original study as a PDF. The study authors are Robert A. Lowe, MD, MPH, K. John McConnell, PhD, Molly E. Vogt, MA and Jeanene A. Smith, MD, MPH.
While it is true that some of the uninsured ER visits are related to drugs and alcohol, many more are simply visits by people who have no access to decent health care. I work in DHS offices, and I see the effects of the current system on our clients every day. One practice that probably results in increased costs and visits is the current practice of giving patients who come into emergency rooms without insurance pain medications and then sending them back out the doors. This happens to our clients who are covered by Medicaid and OHP. Often these clients have only coverage for medical emergencies, so they HAVE to go to the ER for ANY medical treatment, even if it could have been treated at an urgent care center or PREVENTED if they went to see a family practitioner or internist when they first had symptoms. I have seen conditions that began as moderate problems turn into medically acute emergencies because of this. I have seen clients die of diabetic ketoacidosis simply because they had no access. Last week one of my clients ended up in the ER - again -- after being in there two to three times per week for the past 8 weeks trying to get help for severe abdominal pain. This time, the client went in vomiting blood. God help them if they don't speak English well enough to convey what is wrong. The hospital has to obtain and pay for an interpreter, something which delays treatment and costs everyone more money.
There are the mentally ill and addicts who end up in the ER because they want a warm, safe place to sleep that night and a meal. Some end up there because they know that they will get some relief from their withdrawal symptoms if they can't get their drugs that day. Of course these people would be better treated in another setting, but the ER is what is available.
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