NCPA - National Center for Policy Analysis


October 23, 2008

The uninsured are not responsible for overcrowding in the nation's hospital emergency departments; rather, insured patients represent the majority of the increased use of the nation's emergency departments over the past decade, says a new study published in the Journal of the American Medical Association.

Even medical researchers get that wrong, say the study's authors, who reviewed work in medical journals and found three common misconceptions about the uninsured and their use of emergency departments.  Those myths are:

  • The uninsured use the emergency department for non-urgent care.
  • They are the leading cause of ER crowding.
  • They use the ER disproportionately to their share of the population.

In fact, researchers found:

  • A higher proportion of patients with public insurance, such as Medicaid and Medicare, use emergency departments than the uninsured.
  • Yet, the uninsured do represent a large percentage of patients in some hospitals where the surrounding city has high levels of uninsured residents.
  • Uninsured patients are less likely than insured patients to visit the ER for non-urgent problems; that's partly because it costs patients so much more to go to the ER than to other types of care.
  • The number of visits to ERs nationally rose 19 percent from 1995-2005, even as the number of hospital ERs fell by nine percent.

Furthermore, overcrowding in ERs has many causes such as patients being unable to be moved from emergency departments if other parts of the hospital are full or don't have enough staff.  And people with insurance often go to the ER for problems that could be handled in a doctor's office because they face long waits to see their own doctor -- or need help after-hours, say researchers. 

Source: Julie Appleby, "Study tries to debunk myths of ERs, uninsured," USA Today, October 21, 2008; based upon: Manya Newton, et al., "Uninsured Adults Presenting to US Emergency Departments: Assumptions vs Data," Journal of the American Medical Association, Vol. 300, No. 16, October 22/29, 2008.

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