by jasonP

An interesting article claims that the Healthcare Reform will create more crowding in Emergency Rooms. While the reforms are meant to get more people on insurance, and give more people access to normal healthcare from primary care physicians, the changes will also put 16 million new patients on Medicaid.

The article claims that the current load in most ERs is predominantly based on Medicaid patients. The uninsured are less likely to go to the ER for moderately critical needs, for fear of large bills. But Medicaid patients will often go to the ER for non-emergent needs, since they do not have to worry as much about the additional expenses. These patients often have limited access to family doctors, because most family doctors only accept a small amount of Medicaid patients. The doctors already get paid a small amount for Medicare patients, and the healthcare reform will be reducing those amounts even further.

To support the prediction, we can look at Massachusetts, which enacted major healthcare reform laws in 2006. The new federal legislation is largely based on the Massachusetts reforms. From the article: “Massachusetts reported a 7 percent increase in ER visits between 2005 and 2007. A more recent estimate drawn from Boston area hospitals showed an ER visit increase of 4 percent from 2006 to 2008 – not dramatic, but still a bit ahead of national trends.”

So, what does this mean to you and me? For a different interpretation, I talked to my brother, who has been an ER nurse for 19 years. Here is his take:

The current ER patient, with Medicaid or without insurance, is often a critical case. Someone who should have sought medical care days or weeks ago, who ends up with an ambulance ride, and a trip ‘upstairs’ for a few days. They create a bill in the thousands of dollars very quickly. If they have Medicaid, but no access to a family doctor, then they would likely visit the ER sooner, when they aren’t so critical. The can drive in, or catch a bus, instead of an ambulance. They can get some treatment and go home, instead of being admitted for days. Their care and recovery will be quicker, and costs could be orders of magnitude less. That earlier intervention could reduce admissions significantly, and save 80-90% of a typical ER bill.

So, maybe there will be more people going to the ER, but maybe the ER can treat less-critical cases faster, and actually reduce wait times. And maybe the system can save millions or even billions of dollars.

The real solution would be to get normal primary care for those Medicare patients, but that is a much bigger problem.