AHA Study: ED use by the indigent is rising sharply (SSI to blame?)

In an AHA study that spanned the decade between 1997 and 2007, the Journal of the American Hospital Association noted that Hospital Emergency Department visits rose nearly double the rate of growth for which population increases would account. The section of the population most heavily contributing to this increase are adults receiving Medicaid, whose visits per 1000 people rose from 693.7 to 947.2. This is a particularly startling trend considering that the data studied here really does not encapsulate the challenging economic times that the country has faced in the past two years.

Commentary on the study suggests that the Adult Medicaid population increasingly uses the emergency department to seek treatment due to a lack of availability of primary care from general practitioners. Clearly this contributes to crowding of the EDs, and could result in a poorer or delayed quality of care received there.

Clearly a generous portion of the Medicaid recipients are receiving their benefits as a result of qualifying for SSI. Much state aid is predicated on the receipt thereof. As one can see from the graph below, there was a considerable increase in the disabled population during the time frame of the study, and that trend continues at an accelerated rate.

All Social Security disabled beneficiaries in current-payment status, December 1970–2009

Ultimately, these issues need to be addressed immediately, or we can expect to see continued crowding in ED, decline in patient-doctor consultative time, or worse, the bifurcation of the provision of medical services into a private vs. public system, where those with money pay for quality, and those without receive poor care or none at all. Whether or not the health reform bill that was recently passed will accomplish this remains to be seen.

• Please contact Thomas O'Brien at Feiler & Associates with questions.