ED Usage Lower Among Some Groups

Communities with high numbers of Hispanics, immigrants and the uninsured have lower usage rates for emergency departments than communities with higher numbers of residents in the three groups, "[c]ountering a popular belief" that members of the three groups "are clogging ambulances and emergency rooms for last minute care, according to a Health Affairs Web exclusive, USA Today reports (Appleby, USA Today, 7/18).

For the study, researchers from the Center for Studying Health System Change surveyed 46,000 individuals in 60 communities nationwide (Dorschner, Miami Herald, 7/18). They found that use of EDs varied by community, with an average of 32 visits per 100 residents.

Orange County, Calif., had the lowest ED usage rate at 21 visits per 100 individuals in 2003 (USA Today, 7/18). Both Orange County and Phoenix, Ariz. -- which also had a low ED usage rate -- have high numbers of uninsured and immigrant residents (Miami Herald, 7/18).

By contrast, Cleveland had the highest rate of ED usage with 40 visits per 100 residents, yet the city has low numbers of uninsured and immigrant residents, USA Today reports (USA Today, 7/18). Boston -- which also has relatively few uninsured, Hispanic and immigrant residents -- also had a high ED usage rate (Miami Herald, 7/18).

The study finds that:

• The elderly, those who live in places where it is difficult to obtain a doctor's appointment and those who live in communities where fewer individuals are enrolled in HMOs were the most likely to visit EDs (USA Today, 7/18);
  
  
• Uninsured individuals had 16 fewer visits to the ED per 100 people than Medicaid beneficiaries and 20 fewer visits than seniors with Medicare, according to the study's author, Peter Cunningham, a senior fellow at HSC;
  
  
• Immigrants had 17 fewer visits per 100 individuals;
  
  
• Blacks visited the ED more frequently than Hispanics, perhaps because they were more likely to have some form of health insurance (Miami Herald, 7/18).

Cunningham said, "Emergency room use is up across the population, including more middle-class folks with private insurance." He added, "While there are individual hospitals along the border or in some inner-city areas that may be experiencing a large increase, the larger perspective is that uninsured Hispanic immigrants generally are not heavy users of emergency departments."

Cunningham said that the uninsured often avoid medical treatment because of the expense, while illegal immigrants might be afraid of being deported.

Caroline Steinberg, vice president of the American Hospital Association, said, "The sad fact is that people without health insurance do seek less health care, but when they do they tend to be sicker because they put off care" (USA Today, 7/18).