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September 30, 2003
Largest Increase in Decade of Uninsured will Intensify
Strain on Emergency Departments
Washington, DC - The increase in the number of Americans
without health insurance will intensify the strain on the
nation's overcrowded emergency departments and the ability
of emergency physicians to provide care for all patients,
said George Molzen, MD, President of the American College
of Emergency Physicians (ACEP), in response to figures released
by the Census Bureau. Dr. Molzen said the new Census data,
which found 2.4 million more Americans to be uninsured in
2002, signal a call to action.
"Inadequate coverage for uninsured and underinsured
patients, along with reimbursement cuts, are contributing
to the closure of emergency departments across the United
States and threatening the ability of emergency physicians
to continue provide high-quality care for all patients,
not just the disadvantaged.
"When people do not have health insurance, they
turn to emergency departments for medical care. These
patients are coming sicker than ever before, as shown
by the fact that only 9.1 percent of emergency visits
[of all patients] were classified as nonurgent in 2001.
The financial toll of the uninsured is greatest on the
nation's emergency care system. More than half of emergency
services go uncompensated.
"With more people becoming uninsured, combined with
significant reductions in hospital staff and reimbursement,
acutely ill patients will wait longer for admission to
the hospital, which means patients in the waiting room
will wait longer as well. When patient beds are not available
in a hospital, acutely ill patients may wait for days
in an emergency department, which can severely strain
the resources and staff and render the department unable
to treat additional patients.
"The health care system is at the breaking point,
and the problem of overcrowding will not be solved in
the emergency department alone."
A recent GAO report found the failure to move patients
from an emergency bed to a hospital inpatient bed plays
a major role in crowding. The practice results in patients
being "boarded" in emergency departments, which
further shrinks emergency department resources to treat
severely injured and sick patients. It also limits a hospital's
ability to meet periodic surges in demand, such as those
from disasters. The GAO said hospitals did not always meet
the demand for inpatient beds from emergency patients because
of financial pressures.
Emergency departments have the only universal mandate for
providing health care * EMTALA [Emergency Medical Treatment
and Labor Act] to care for patients, regardless of their
ability to pay or insurance status. The nation's more than
4,000 hospital emergency departments are a portal for as
many as three out of four uninsured patients admitted to
U.S. hospitals. The American Medical Association estimated
the financial toll of EMTALA to be greatest on emergency
physicians, who lose on average $138,300 per year as a result
of bad debt incurred as a result of the law.
ACEP is a national medical specialty society representing
emergency medicine with more than 22,000 members. ACEP is
committed to improving the quality of emergency care through
continuing education, research and public education. Headquartered
in Dallas, Texas, ACEP has 53 chapters, representing each
state, as well as Puerto Rico and the District of Columbia,
and a Government Services Chapter which represents emergency
physicians employed by military branches and other government
agencies.
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