These two things might be connected. The Washington
Post reported yesterday on the findings of a CDC report on
emergency room preparedness. The Economic Policy Institute
reported on further erosion in health insurance coverage.
ERs Raise Concerns On Readiness
By Christopher Lee
Washington Post Staff Writer
Thursday, September 28, 2006; Page A11
Emergency rooms at many hospitals are routinely stretched to the
breaking point, raising concerns that they would not be able to handle
victims during a terrorist attack or natural disaster, according to
congressional testimony yesterday and a new federal study.
Between 40 percent and 50 percent of emergency departments experienced
crowding during 2003 and 2004, the study by the Centers for Disease
Control and Prevention found. It deemed an emergency room to be crowded
if so many patients flooded in that ambulances had to be diverted to
other hospitals; if people in urgent need of care had to wait an
average of more than an hour; or if at least 3 percent of patients
simply gave up and left before being seen....
insurance eroding for working families
coverage declines for fifth consecutive year
September 28, 2006 | EPI Briefing Paper #175
by Elise Gould
More Americans are uninsured because of the continued erosion in
employer-provided health insurance, the most prominent form of U.S.
health insurance. The number of people without health insurance grew
significantly for the fifth year in a row. Nearly 46.6 million
Americans were uninsured in 2005—up almost 7 million since
2000. The rate of those without insurance has grown 1.7 percentage
points during this period, from 14.2% in 2000 to 15.9% in 2005...
...As with workers, the downward trend in employer-provided coverage
for children continued into 2005. In the previous four years, children
were less likely to become uninsured as public-sector health coverage
expanded. This year that trend reversed and the number of uninsured
children rose 361,000 to 8.3 million in 2005. This is the first time in
seven years that the rate of uninsured children has increased....
The WaPo article mentioned that the problem 0f crowded emergency
departments in drawing attention in Congress. They quote
spokespersons from the American College of Emergency Physicians and the
Emergency Nurses Association, and various other organizations.
Everyone agrees that it is a problem.
They have some reasonable ideas. For example, it was
suggested that the VA health system could be tapped in the event of a
civilian emergency. That would make sense, but only for
Others say that we need to find ways to reduce overcrowding.
Increasing the proportion of persons with insurance would
help. To some extent, allowing insurance programs to
deteriorate in effectiveness is exacerbating the problem.
The basic problem, though, is the fact that surge capacity is extremely
expensive. In order to have surge capacity, you have to have
some highly-compensated persons who are getting paid while not seeing
patients, and some expensive physical structures that are being
maintained while not being used.
We can't approach this problem simply be spending more money.
We would need to have some sort of policy analysis to show if
that would be a good use of scarce resources. We know there
will be natural disasters; we think there will be more terrorist
attacks. But how much do we want to spend on that, while
other problems compete for our attention and resources?
I was actually just discussing this topic the other day with one of our CDONs. It will be interesting to see whether Massachussetts sees a reduction in ED overcrowding after (if) they implement their proposed policies to require health insurance for the vast majority of all their citizens.
I think one thing that might help directly, and be easier to implement, would be to expand the locally-run public health clinics that exist in most cities into subactute medical centers to deal with the basic non-emergency healthcare needs that often force thoe without health insurance to utilize the EDs unecessarily. This would have a wonderful side-effect of creating potential surge capacity if these medical centers could be modified, in an emergency, into basic triage and treament centers.