ER OVERCROWDING & GOV’T MEDDLING

The CDC’s report on ER overcrowding is out, and the news isn’t good. ED visits are up 20 percent over the last ten years and the number of EDs actually available to treat these patients has dropped by 9% during the same period. What could be causing this? GruntDoc has a nice, succinct theory:

If you subsidize something, you get more of it.

And who would be stupid enough to subsidize visits to already overcrowded emergency rooms? Why those geniuses in Washington, of course. Patients with Medicaid/SCHIP coverage, for whom such visits are essentially free, are nearly four times more likely to appear in the ED than are patients with private insurance.

And there is, of course, EMTALA. Because this brilliant federal law decrees a “medical screening? for every patient who shows up in the emergency room, regardless of ability to pay, many people with no insurance use the ED as a free clinic. The CDC report indicates that such patients use the ED at twice the rate of privately insured patients.

But take heart! Our masters in Washington are working to “solve? this seemingly intractable problem. This neatly captures the inevitable effect of government intervention in health care. The politicians and bureaucrats meddle with the system, which produces problems. Then, they declare a crisis and meddle some more.

And there are people who actually think we should turn the entire health care system over to these boneheads.

Comments 4

  1. Morris Berg wrote:

    Dave, Dave, Dave . . .

    “Patients with Medicaid/SCHIP coverage, for whom such visits are essentially free, are nearly four times more likely to appear in the ED than are patients with private insurance.”

    While this is technically true, it is also true that those with private insurance account for 1.6 times more ER visits than those on Medicaid/SCHIP (45,999 v. 28,661).

    Now, stats, being what they are . . . and stats comparing population-specific utilization rates across populations for one year being what they are . . . let’s dig a little deeper.

    Assuming this measure (visit rate) is actually an appropriate one to support rather sweeping macroeconomic conclusions (confounds be damned), let’s try another way to try and isolate “get more of it.” Now, since we know that these numbers have nothing at all to do with broader (and more complex) factors (we know health care payment and utilization can be explained with simplistic principles). And since the single-payer lovin’, free-market bashing, unrealistic hippies may try and argue that these groups are just so darned different, why don’t we look at the same groups over time (we’ll just look back one year for now . . . since doctors hate stats)?

    Increase in visit rate (number of visits per 100 persons) – 2004-2005:

    Private insurance
    2004: 20.3
    2005: 23.8
    Increase: 17.24%

    Medicaid/SCHIP
    2004: 80.3
    2005: 89.4
    Increase: 11.33%

    http://www.cdc.gov/nchs/data/ad/ad372.pdf

    Hmmmmm . . . well . . . the federal government boneheads at the CDC did produce this data didn’t they? That prob’ly explains it, huh?

    Posted 26 Jul 2007 at 5:58 pm
  2. Matt wrote:

    YOU think we should leave medicine in the hands of these boneheads. You just want them to pay more.

    Your criticism is weak, given that the only solutions you propose are vague references to more “free market” actions.

    Posted 27 Jul 2007 at 1:57 pm
  3. Catron wrote:

    While this is technically true, it is also true that those with private insurance account for 1.6 times more ER visits than those on Medicaid/SCHIP (45,999 v. 28,661).

    These absolute numbers are meaningless, Morris. What matters is the percentage each group comprises in ED visits compared to their percentages in the general population. As it happens, the percentage of the population covered by Medicaid/SCHIP is about 12%. Yet, their representation in ER visits is 24%. That 2 to 1 ratio compares to a 1 to 1 ratio for private insurance.

    Why don’t we look at the same groups over time (we’ll just look back one year for now . . . since doctors hate stats)?

    You can’t credibly switch from a 10 year analysis to a 1 year analysis in this way. If you wish to ignore the Private Insurance/Medicaid SCHIP numbers, here’s another comparison to contemplate: The general population goes to the ED at a rate of 39.6 visits per 100 persons. The Medicaid/SCHIP population goes at a rate 89.4. No amount of statistical tap dancing will cover up the obvious implications of those numbers.

    Posted 27 Jul 2007 at 8:42 pm
  4. Catron wrote:

    Matt, you’re babbling incoherently.

    Posted 27 Jul 2007 at 8:45 pm

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