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Growing Pressures Converge in Hospital Emergency Departments (EDs)
On-Call Coverage, Primary Care Use and More Seriously Mentally Ill Patients Strain Eds
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The rising pressure in emergency departments is a result of larger forces throughout the health care system, including financial incentives that reward specialist physicians for performing more procedures outside general hospitals; diminishing access to primary care; declining funding for community-based mental health services; and financial pressures on hospitals to pursue business strategies of seeking higher-paying patients and services, the study found.
"Failure to deal with these underlying problems in the health care system threatens to compromise access to emergency care for patients and add to rising health care costs," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded principally by The Robert Wood Johnson Foundation.
Numerous reasons were cited for specialist physicians waning interest in taking ED on-call coverage: the perceived higher risk of malpractice litigation, lack of reimbursement for uninsured patients, opportunity costs in terms of time away from their practices and late and unpredictable hours.
"Historically, emergency on-call coverage has been part of a physicians obligation in return for hospital admitting privileges, and as specialists provide more services outside general hospitals, they are less dependent on having privileges at general hospitals," said HSC Senior Researcher Ann S. OMalley, M.D., coauthor of the study with HSC Health Research Assistant Anneliese M. Gerland; HSC Senior Researcher Hoangmai H. Pham, M.D.; and HSC Senior Consulting Researcher Robert Berenson, M.D., of the Urban Institute.
Along with providing stand-ready capacity to respond to life-threatening injuries and illnesses ranging from head traumas to heart attacks, emergency departments also serve as the care provider of last resort for insured and uninsured patients alike who cannot access care elsewhere. Emergency departments are the one place in the U.S. health system whereunder federal lawpeople cant be turned away regardless of their insurance status or ability to pay.
In the face of these pressures, ED visit rates continue to grow steadily. During the past decade, the number of ED visits nationally rose 26 percentfrom 90 million to 114 million in 2003much faster than the 11 percent growth in the U.S. population during the same period.
The studys findings are detailed in a new HSC Issue BriefRising Pressure: Hospital Emergency Departments as Barometers of the Health Care Systemavailable here. The study is based on HSCs 2005 site visits to 12 nationally representative communities: Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y.
Other key findings of the study include:
The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nations changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by The Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.