Medicaid patients often cannot obtain medical care from physicians in their community because doctors refuse acceptance of Medicaid insurance due to very low reimbursement rates. This is increasingly true for patients with Medicare, as well. When people cannot obtain timely care from physicians, they may have no choice but to seek care in the emergency department.
People who cannot afford to pay for medical care and who have no health insurance often turn to emergency departments for treatment of conditions that have become acute because they lack access to regular medical care. Emergency physicians see first-hand the consequences of a health care system in which over 45 million people are uninsured and millions more are under-insured. The nation’s nearly 4,000 hospital emergency departments are a portal for as many as three out of four uninsured patients admitted to U.S. hospitals.
The scarcity of primary care practitioners in inner cities and rural areas contributes to an increasing reliance on emergency departments. In addition, some workers are unable to take time off to see their physicians within 1 or 2 days for unanticipated illnesses or injuries. Emergency departments are often the only source of medical care available at night, on weekends, and on holidays.
Strategies to restrict emergency department use disproportionately burden the poor and minorities, who often are sicker and more reliant on emergency departments for care. Physicians have a moral and ethical obligation to provide care, and although individual insurers may save money by keeping their members out of emergency departments, the system as a whole will not save money.
Restricting patients from emergency care will have little effect on society's health costs, and treating patients for nonurgent conditions, which can include fractures, wounds, and bronchitis, can prevent development of more serious and costly health problems, such as pneumonia.