Nearly two-thirds of emergency departments were classified as safety net hospitals in 2007 – nearly double the number classified as such in 1997, according to a recent study.
Safety net hospitals are defined as providing a "disproportionate share of services to Medicaid and uninsured patients."
The new study, published in the Journal of the American Medical Association, also found that emergency visit rates have increased at twice the rate of growth of the U.S. population from 1997 to 2007. Medicaid patients accounted for a large proportion of the increase, often coming in with more severe illnesses and complications.
Study authors say factors that are likely to influence future results include the recession, record job losses in 2008 and 2009, the estimated 5.8 million Americans who are uninsured and another estimated 5.4 million enrolling in Medicaid and the State Children’s Health Insurance Program (SCHIP).
“Emergency departments provide a healthcare safety net for everyone, not just the uninsured,” said Angela Gardner, president of the American College of Emergency Physicians. “But Medicaid pays so poorly in many states that physicians limit the number of Medicaid patients they will see. When these patients get sick but can’t get in to see a physician, they often wait until an illness has worsened to the point that they need care in an emergency department.”
“This is important to remember, especially as the nation implements the new healthcare reform law,” she said. “Health plans must provide fair payment for services, or patients will suffer.”
According to the report, the increase in emergency room visits is almost double what would be expected from population growth during this period. Conversely, the number of emergency departments has decreased from 4,114 in 1997 to 3,925 in 2007.
“Decreasing reimbursements for emergency care and growing levels of uncompensated care related to caring for millions of uninsured patients have contributed to the closure of hundreds of emergency departments across the country and a lack of emergency resources,” said Gardner. “This limits everyone’s access to lifesaving emergency care.”
The ACEP is a national medical specialty society headquartered in Dallas. It represents emergency medicine with more than 28,000 members.