More Uninsured Patients Seen in Emergency Rooms

Forty-four million Americans, including more than 8 million children, lacked health care coverage for an entire year, according to statistics released in 2003 by the U.S. Census Bureau.

With more people lacking basic health insurance, emergency room physicians are treating ever-increasing numbers of uninsured patients, according to a survey by the American College of Emergency Physicians.

About 70 percent of emergency physicians say they've seen more uninsured patients in the past year, the survey found, and about 80 percent say they expect to see more still in the next year.

The survey queried nearly 2,000 emergency physicians across the nation. Results of the survey, which was funded by the Robert Wood Johnson Foundation, were released at Harborview Medical Center in May 2004 as part of "Cover the Uninsured Week," a nationwide effort to promote health-care coverage for all Americans.

Of the physicians surveyed, 74 percent said their uninsured patients are more likely to die prematurely. Another 57 percent said the top priority in improving the United States health-care system is providing basic health coverage to all Americans.

Dr. Michael Copass, longtime chief of emergency services at Harborview, has seen firsthand the results of patients not having health insurance coverage.

"Each year, we see an increasing number of uninsured patients," said Copass. "We treat and stabilize them in the Emergency Department, but after they are released, many are faced with the decision of whether to spend their money to fill a prescription, follow a recommendation to see a specialist for follow-up care, or buy groceries that week. That's a choice no one should be forced to make."

Surveyed physicians said they believe that nearly one-third of their patients lack health coverage, with about one-fourth of those uninsured patients under 18 years old. An overwhelming majority of physicians, 82 percent, also said the emergency department at their hospital is at or over its capacity on a typical weekday, while 91 percent said the same about a typical weekend.

People who lack insurance often can't afford regular doctor visits to stay well or to keep their medical conditions from getting worse.

"Many uninsured patients end up in the emergency department because they did not receive the preventive care they needed earlier," explained Dr. John Lumpkin, an emergency physician and director of the health-care group of the Robert Wood Johnson Foundation, which sponsored the survey and "Cover the Uninsured Week."

"Many uninsured patients don't have a physician they can see regularly for check-ups," Lumpkin said. "Consequently, they arrive in the emergency department as a last resort, frequently much sicker than they would have been if they had access to primary and preventive care."

Lack of health insurance is affecting more and more people in Washington state. In recent years, health-care costs in Washington state have risen far faster than workers' earnings, according to the Working for Health Coalition, a group of health care, labor, faith, and education organizations. Health insurance and medical bills have become unaffordable for many, and more people, insured and uninsured, are declaring bankruptcy due to medical debt, according to "Risky Business: Working People Losing Health Coverage," a report released in 2004 by the coalition.

The problem has grown to the extent that the coalition suggests that the state, the private sector, and employee groups should use their joint purchasing power to implement better and less expensive health systems.

The Working for Health Coalition was organized by Dr. Robert Crittenden, chief of family medicine at Harborview, and Amity Neumeister, director of clinical systems development in the Office of Medical Affairs. The coalition was convened after the recommendation of the Task Force for the Uninsured and Underinsured, a group led by Dr. John Coombs, associate vice president for medical affairs, clinical systems, and community relations, and vice dean for regional affairs, rural health, and graduate medical education.