Who Is Clogging Up Hospital Emergency Rooms?

You've heard before that uninsured patients are the ones who are responsible for running up waiting times at hospital emergency rooms for non-urgent care. In fact, using a tightly-focused Google search for "crowded emergency rooms" and "uninsured," we found some 127 news articles and editorials from major media outlets around the United States spanning the period 20 January 2001 through 31 May 2009 that have represented this claim as a major contributing factor in producing crowded emergency rooms. These media organizations include USA Today, the New York Times, Los Angeles Times, CBS News, CBS Marketwatch, Las Vegas Review Journal, Charlotte Observer, San Francisco Chronicle, Palm Beach Post and most recently, the Jacksonville Times-Union.

The problem with repeating this claim as part of the health care reform mantra that many of these media organizations endorse is that it turns out to be a myth.

That's the finding of Canadian graduate student Andre Maddison, who challenged the assumption that patients seeking routine or non-urgent care are behind the clogging of hospital emergency rooms in Canada as part of the Canadian Health Services Research Foundation's Mythbusters competition for 2009, in which he was a co-winner of the top prize.

Although Canada has a single-payer system that theoretically provides health care for all Canadians, it has also seen its emergency rooms become very crowded during the same period as the U.S. The belief that this crowding is due to patients seeking non-urgent care is directly equivalent to the impact that uninsured patients are believed to have upon the crowding of hospital emergency rooms in the United States. In the section below, Maddison describes the path his research took into Canada's crowded emergency departments, or "EDs" (via Physorg):

"I started with the view that due to a shortage of family doctors, people are going to emergency departments and overcrowding them," explains Mr. Maddison, a native of Sarnia, Ont. "But in reality, why EDs are overcrowded wasn't known."

While 40 to 50 per cent of cases in the ER are non-urgent patients, after extensive literature research and speaking with physicians, Mr. Maddison found that primary care patients were not overly burdensome. His research illustrated that patients in urgent need of acute-care, admitting beds, extended stay, specialists and other high demand care needs actually have a greater impact on overcrowding. "We can't discount the affect of so many non-urgent patients, but they are certainly not the main part of the problem."

Having ruled out non-urgent patients as being a large contributor to the problem of overcrowded emergency rooms, Maddison focuses on problems elsewhere in the system:

Mr. Maddison believes it's a system level problem, not isolated to the ED. "Emergency department overcrowding is a national problem with potentially devastating effects," he says. "It is rooted in insufficient physical and human resources and poor integration within and between hospitals."

We would translate "insufficient physical and human resources" as "chronic underinvestment in critical health care infrastructure" and "excessive limitation of compensation for health care professionals."

As for "poor integration within and between hospitals," we find it unsurprising that a nation with a long-established universal health care system staffed with the brightest and most talented planners and managers produced by the nation's most elite academic institutions would prove incapable of solving the problem of how to provide health care efficiently and effectively within the system they completely control.