Massachusetts universal coverage does not reduce ED visits, polls say

Physicians stress the need to address overcrowding and boarding in hospital emergency departments.

By Susan J. Landers — Posted Oct. 20, 2009

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A survey of Massachusetts emergency physicians found that the number of patients seeking emergency care increased after the enactment of state health system reform three years ago.

The poll, conducted by the American College of Emergency Physicians, showed that 42% of the 138 physicians surveyed said emergency care had "somewhat increased" since the reforms took effect, and 22% said such care had "significantly increased." About one in three respondents said the number remained the same.

Proponents of health system reform argue that universal health insurance coverage will lead to less care being provided in emergency departments. But the survey shows that EDs will continue to play an important role in the delivery of health care in a reformed system, said Peter Smulowitz, MD, an emergency physician at Beth Israel Deaconess Medical Center in Boston. He detailed the findings Oct. 6 at the ACEP annual meeting in Boston.

A second survey of about 1,000 state residents, commissioned by ACEP and conducted by Harris Interactive, revealed that nearly half had sought care at an ED during the past year, despite having health insurance.

That finding supports the idea that EDs are not just being used by people without insurance or other access to care. "The idea that emergency departments are filled with people who don't need to be there is simply not true," said ACEP President Angela Gardner, MD. "People will always need emergency care."

Massachusetts requires nearly everyone in the state to obtain health insurance. State figures put the number of uninsured residents at 2.6%, the lowest rate in the nation.

"Providing universal access to health insurance is a fundamental value, but it does not accomplish everything that we need to do for our health care system." Dr. Smulowitz said, "Though it's an important first step."

The debate on national health system reform does not address the problems of excessive wait times for care in EDs, overcrowded conditions and boarding of patients in EDs until beds open up in inpatient units, Dr. Smulowitz said.

"More than 62% of emergency physicians polled said that boarding has increased or stayed the same since the Massachusetts mandate," Dr. Smulowitz said. "Boarding is the primary cause of overcrowding."

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