The San Francisco Chronicle (California)
Copyright 2006 The Chronicle Publishing Co.
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A recent study showing that uninsured and illegal immigrants shouldn’t be blamed for the nation’s overcrowded emergency rooms begs the question: Who should be?
The Center for Studying Health System Change analyzed about 46,000 people in 12 communities. They discovered that communities with high numbers of uninsured and immigrant residents tended to have lower rates of emergency-room use, while those with low numbers of uninsured and immigrant residents tended to have higher rates. In doing so, they’ve killed the argument that denying hospital access to illegal immigrants will improve our pitiable health-care system. But it points to a sobering conclusion about the quality of care for all patients — including the insured.
It’s no secret that America’s emergency rooms are in crisis. The National Acadamies’ Institute of Medicine issued a condemning report last month that described systematic failures, including long waiting times and routine diversions of ambulance drivers. Considering how much we spend on health care (16 percent of our gross domestic product — more than any other nation), it’s sad that our system is so sick.
In the search for a culprit for our health-care problems, many have turned to two groups of people — the uninsured and illegal immigrants. Emergency-room care is more expensive than outpatient care, and because ERs must care for everyone, it would seem to make sense that these two groups are overusing the service.
But Peter Cunningham, author of the Center for Studying Health System Change’s study, said that it’s more true that these groups rarely go to the hospital at all.
“You have to make a distinction between greater dependence on the ER versus greater use,” he said. “In fact, we found that immigrants and the uninsured tended to use less of everything — fewer trips to the ER, fewer prescription drugs and fewer doctor visits.”
Instead, the people clogging the ER are the insured who can’t reach their regular doctor. Cunningham found that communities with fewer or busier doctors tended to have higher rates of ER use. It makes sense — ERs are open 24 hours a day, 7 days a week. Unlike at a regular doctor’s visit, patients can receive a diagnosis, testing and treatment all at once. With the health-care system’s other constraints — community-hospital closures, a shortage of health-care workers and a growing elderly population — it’s no wonder that the insured are flooding into ERs, frustrated by the outpatient system. But if choices for the insured have grown this limited, imagine how things are for everyone else. Illegal immigrants and the uninsured are easy culprits for our health crisis. Unfortunately, the real cause is harder to see.