Growing Number of Uninsured State Residents Visiting Private Emergency Departments, Study Finds

The number of uninsured patients who visited emergency departments in private hospitals in Los Angeles County increased by one-third in the last five years, according to a report from the Hospital Association of Southern California, the Los Angeles Times reports.

The report, the first to quantify the trend, was performed by researchers at the National Health Foundation. They found that many former patients of Los Angeles County public hospitals are now visiting private EDs, contributing to a 27% decline in emergency visits to public hospitals between 2000 and 2005.

Hospital officials say the trend is primarily responsible for the closure of nine private hospitals and EDs in Los Angeles County in recent years, as facilities encounter budget shortfalls and a shortage of medical staff.

Administrators at private hospitals say they are "losing millions of dollars" from ED visits by the uninsured, contributing to the closure of some hospitals, the Times reports.

In the year after Los Angeles County closed several nearby clinics in 2002, the number of visits by uninsured patients at Downey Regional Medical Center's increased from 40,000 to 50,000, Rob Fuller, chief operating officer at the center, said. As a result, the hospital's charity care costs from emergency treatment increased from $1 million in 2002 to $6 million in 2004, Fuller said. He added, "We need to find a way to compensate private hospitals for providing massive amounts of care for the uninsured. Or frankly, we're going to se a lot more hospitals go out of business."

Katreena Salgado, a spokesperson for California Hospital Medical Center in Los Angeles, said the facility has seen the number of uninsured patients double in the last two years. "We take our responsibility for the uninsured seriously," she said, adding, "But a lot of the losses we're experiencing can be attributed to this issue."

The county Department of Health Services acknowledged that it has closed 15 community clinics since 2002 and reduced the number of transfers it accepts at its hospitals.

However, Jonathan Fielding, director of the county DHS, said the closure of public facilities is only one factor in the rising burden on private hospitals. Another factor is an overall increase in the number of uninsured residents, he said.

Jim Lott, a spokesperson for HASC, estimated that the cost of providing care to uninsured patients at private EDs increased from $63 million in 2000 to $77.5 million in 2004. "Maybe 10% to 15% of that cost would be paid by patients," Lott said, adding, "So we're talking 85% to 90% actual losses to the hospital."

Lark Galloway-Gilliam, executive director of Community Health Councils, said the study is not conclusive, adding that many patients who visit EDs ultimately pay at least part of their medical bills. She expressed concern that the shift to private EDs could result in an increase in medical debts and bankruptcies among the uninsured (Chong, Los Angeles Times, 4/15).