By LEE BOWMAN
Scripps Howard News Service
July 19, 2006
Instead, the Center for Studying Health System Change in Washington reported that such communities generally had lower rates of emergency department use than those with low numbers of uninsured or non-citizen residents.
The center found that emergency department use in 12 nationally representative communities varied considerably in 2002 from the national average of 32 visits per 100 people. Nationwide, visits to emergency rooms increased by 26 percent between 1993 and 2003, to some 114 million a year.
The highest rate was in Cleveland, with 40 visits per 100 people; the lowest was in Orange County, Calif., with a rate of 21 visits per 100 residents.
Yet in Cleveland, 7.9 percent of residents were uninsured at that time, and 3.2 percent were not U.S. citizens; in Orange County, 18.2 percent of the population had no health coverage and 15.6 percent were immigrants who were not citizens.
"The findings are surprising and make it clear that reducing emergency department use defies simple solutions such as restricting access for non-citizens or expanding insurance coverage," said study author Peter Cunningham, a senior fellow at the center, a health policy research organization. The research was published online Tuesday by the journal Health Affairs.
He said that while a rapid influx of immigrants may contribute to emergency ward crowding in some hospitals, especially near the Mexican border, immigration is not a major contributing factor to ER crowding nationally, even in many communities that have large populations of Hispanic immigrants.
"Hispanic immigrants - a high proportion of whom are uninsured - are not heavy users of (emergency departments) compared with other individuals, including whites with private insurance," said Cunningham. "And their numbers are still too small in the vast majority of communities nationwide to have a major impact on their health care system in those communities."
Non-citizens in 2003 on average had about 17 fewer emergency room visits per 100 residents than citizens, while uninsured people had on average 16 fewer visits per 100 than Medicaid patients, 20 fewer visits per 100 than Medicare patients, and roughly the same rates as privately insured people.
Data for the study came from the center's nationally representative 2003 household survey, which includes information on about 46,000 people. This includes in-depth reports on the 12 communities - Boston; Greenville, S.C.; Little Rock, Ark.; Syracuse, N.Y.; Indianapolis; Seattle; Lansing, Mich.; northern New Jersey; Miami; Phoenix; Cleveland and Orange County. The study found similar ER use patterns in 60 other communities covered by the household survey.
Overall, about a third of all trips to the emergency room are not for problems that are considered true medical emergencies.
The study also found that people were more likely to seek care in emergency rooms in communities where there were fewer physicians and thus longer waits for doctor's appointments.
And it found that people were less likely to turn to an ER in communities where there is higher enrollment in health maintenance organizations and greater availability of community health centers.
Cunningham said the survey did show that people who were at or near the poverty level and who had chronic medical conditions or said they were in fair or poor health were more likely to use emergency departments.
But he concluded that the demographics of a community only partially explain why people there gravitate to emergency rooms, noting that in some places, people use them more regardless of income or insurance status, possibly reflecting practice patterns among physicians and other providers and the prevalence or lack of alternative care from urgent care centers and after-hours clinics.
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