Who's Using The ER's?

[mrjarrell]

We often hear it said that Hispanics are disproportionally overusing services at ER's and that this is leading to a breakdown of some sort in the welfare system. Well, according to the CDC, that's just not true. The leading users of ER's are old people, blacks and the poor. Whites use the ER more often, than hispanics. This, like the hispanic crime wave nonsense, is no more than a base canard.

via the CDC

Key findings

• Older adults (aged 75 and over), non-Hispanic black persons, poor persons, and persons with Medicaid coverage were more likely to have had at least one emergency department (ED) visit in a 12-month period than those in other age, race, income, and insurance groups.
• Among the under-65 population, the uninsured were no more likely than the insured to have had at least one ED visit in a 12-month period.
• Persons with Medicaid coverage were more likely to have had multiple visits to the ED in a 12-month period than those with private insurance and the uninsured.
• ED visits by the uninsured were no more likely to be triaged as nonurgent than visits by those with private insurance or Medicaid coverage.
• Persons with and without a usual source of medical care were equally likely to have had one or more ED visits in a 12-month period.

Since 1996, demand for emergency services in the United States has been rising (1). While the number of emergency departments (EDs) across the country has decreased, the number of ED visits has increased (1). As a result, EDs are experiencing higher patient volume and overcrowding, and patients seeking care are experiencing longer wait times (2,3). As national health care costs continue to rise and policymakers become increasingly interested in ways to make the health care system more efficient, it is important to understand the characteristics of those individuals who use EDs--often in place of other sources of ambulatory care.

More info, including the charts and the .pdf of the study at the source.

 

[femurphy77]

I work in a hospital and while I don't spend much time in the ER I will say that the results of the survey tend to reflect what I'm seeing. Unfortunately the majority of the ER visits are for trivial crap they should see their family doctor for or man up, take a couple of tylenol and get over it.

I would probably be making a safe bet the the hispanics that are in the ER's are for the most part are truly in need of that level of service. I would think that they would be suspicious of any type of setting that would place them at risk of being nabbed. Our ER has plenty of armed security personnel with full arrest powers although they aren't looking for border jumpers. I just can't see them risking deportation over a cold. A pregnancy on the other hand is carte blanche because "we can't deport the parents now, their child is an American citizen"!!!

Who the flock ever dreamed up that rule should be castrated, fed the jewels and then shot!

 

[88GT]

Interesting. Though I've never seen the Hispanic/ER link put in those terms. When it's discussed in my circles, it's always that IF they use medical services, it tends to be ERs because PCPs tend to pay more attention to things AND because ERs can't deny treatment based on ability to pay. It's the latter that is the real problem with use of ERs by illegals. Whether or not their use is disproportionate to their population, I'm betting they still account for a disproportionate amount of the no-pays. It's a win-win for them: can't be denied treatment and they don't have to pay.

Not denying true emergent, life-saving treatment is one thing. But requiring ERs to treat any and all nature of complaints regardless of ability to pay is just stupid. I would love to know how the would numbers crunch out if that were changed.

 

[Phil502]

Yes we hear it because it's true, the lie is that the CDC is watering down the numbers with the rest of the country. The places that are closing are where there is a huge influx of illegals.

L.A. Emergency Rooms Full of Illegal Immigrants - Politics | Republican Party | Democratic Party | Political Spectrum - FOXNews.com

 

[antsi]

Persons with Medicaid coverage were more likely to have had multiple visits to the ED in a 12-month period than those with private insurance and the uninsured.

I staff an OB ER and this is pretty typical of my experience.

The idea that people go to ER's because they don't have insurance doesn't fit my experience at all. The vast majority of patients I see have Medicaid. They have insurance and they are generally registered in clinics for primary care, but the way Medicaid works there is no penalty for frivolous use of emergency services. I get people calling an ambulance at 3 in the morning for a ride to the hospital for a yeast infection. If my wife did that on our plan, we would pay a higher ER copay and probably get stuck with a $1000 bill for a non-emergent ambulance ride - she'd but if she waits until the am and calls her primary, it's a $20 office copay instead of $1000+. So on our plan, we have a built in motivation to use nonemergent services. Medicaid patients don't have those incentives. If 3 am is convenient for them, and an ambulance is the fastest way to get to the hospital, that's what they do.

ED visits by the uninsured were no more likely to be triaged as nonurgent than visits by those with private insurance or Medicaid coverage.

Wrong question. Compare nonurgent visits for Medicaid vs. private insurance with copays. That's where I believe you would see a difference.

Also, "triaged as nonurgent" is not a good marker for this kind of data. In the ER setting there is strong motivation to use urgent codes whenever you can, because you get paid more. So a 24 week pregnant woman with a urinary tract infection making her feel crampy might get coded as "threatened preterm labor" or some such. It's technically not fraud, because a 24 weeker feeling crampy could possibly be preterm labor. But "urgent for coding purposes" and "really medically urgent" are not necessarily the same thing.

Hispanics are disproportionally overusing services at ER's and that this is leading to a breakdown of some sort in the welfare system.

The myth you hear all the time is that universal health care insurance will be cheaper, because all these nonurgent conditions will be seen in the office/clinic rather than the ER. These people would love to go to the office/clinic, the myth goes, but they can't so they go to the ER instead. If we give them coverage, the myth goes, it will save everyone money because we won't be paying for mega$ ER workups every time someone gets a yeast infection.

If you didn't get the hint, my experience - and now the CDC's data - says this line of thinking is mythical, not reality-based.

 

[Srtsi4wd]

Related info.

snopes.com: Parkland Memorial Hospital and Illegal Immigrants

 

[Bill of Rights]

Amen, antsi. I can't tell you how many people I saw when I used to do ER that were either "self-pay" or Gold Card (medicaid), and while the latter technically is a form of insurance, it's one that seemed disproportionately used by people who either spoke little English or who chose to speak Spanish at the ER, often having a young child translate for them.
Admittedly, there were still plenty of us melanin-challenged folks using those services, too, and calling an ambulance rather than fixing the problem at home worked out nicely for them because, in speaking of the ambulance but applicable to ER and pharmacy as well came this little gem: "Well, it's free, ain't it? I got th' Medicaid."

Plenty of money for smokes, booze, and/or a TV too big to fit in most vehicles, but they can't buy furniture, food, or, apparently, Children's Tylenol and a thermometer.

That last is not specifically a Hispanic but a Medicaid issue, but I don't quite get why someone not here legally is eligible for that da*n "Gold Card".

Blessings,
Bill

 

[antsi]

Related info.

snopes.com: Parkland Memorial Hospital and Illegal Immigrants

I do see a number of illegals having babies. I don't see much - if any - frivolous ER usage from these folks. They show up when they're really in labor (not 100 times before labor with every little twitch or cramp), generally do not get epidurals, have fast labors and healthy babies, and generally go home the next morning.

If US citizens used perinatal care like illegals do, and had their same outcomes, our perinatal health care costs would be a fraction of what they are.

 

[MTC]

A pregnancy on the other hand is carte blanche because "we can't deport the parents now, their child is an American citizen"!!!

Who the flock ever dreamed up that rule should be castrated, fed the jewels and then shot!

Jackpot Anchor Babies

“In 1965, the late Senator Ted Kennedy pressed hard for the immigration legislation—it was the first bill he managed through to passage— that eliminated the so-called ‘national origin’ quotas that had been used to keep the flow of immigrants into the U.S. overwhelmingly European. Confronting critics of the bill who had the foresight to question whether it would result in torrential flows of peoples from impoverished lands that would strain America’s ability to assimilate them, Kennedy dismissed even the suggestion that the ethnic and cultural balance of the nation would be impacted and, in a portent of strategy employed by the proponents of mass immigration ever since, he accused the bill’s critics of bigotry.”

“The charges I have mentioned are highly emotional, irrational and with little foundation in fact,” Kennedy said about critics of the bill that raised the alarm it would result in a Third World stampede for American shores. “They are out of line with the obligations of responsible citizenship. They breed hate of our heritage.…”

From my own personal observation, I submit that Kennedy created the beginning of the end of the United States of America. He flooded this country with cultures of poverty, incompatible religions, linguistic chaos and an ecological destruction driven by an added 100 million people in 40 years. If his 1965 bill continues, expect another 70 million third world immigrants and their children within 25 years.

Cromer said, “The assessment that Kennedy was so utterly off the mark in his steadfast assurances that America’s cultural balance would not be dramatically tipped by the legislation is so undeniable that even unwavering liberals acknowledge it—and thank him for it. Just hours after his death, the Daily Kos website posted a homage to Kennedy by Dana Houle that celebrated his efforts to shepherd the 1965 immigration bill to passage.”

“When he was arguing for the act,” Houle writes, “Kennedy tried to assure critics that it wouldn’t significantly change the ethnic makeup of the country. Obviously he was wrong, and it is open to interpretation whether he misjudged the effects or concealed his intents.” Houle notes that in 1960, the foreign-born population of the U.S. was “only 5.4 percent.” Yet by 2000, that figure had jumped to more than 11 percent— a massive demographic shift fueled by an influx of immigrants of which, Houle gushed proudly “Only 16 percent were from Europe.” More than half were from Latin America.

“With every passing day it is increasingly clear that the allure of birthright citizenship has picked up steam during the past four decades, becoming a runaway train, a human locomotive fueled by Latin America’s entrenched misery that has come barreling across the Rio Grande to demographically explode in major American population centers and—with human densities in urbanized regions reaching critical mass—fans out into the heartland.”

Cromer continued, “The policy has created a self-sustaining dynamic on a fundamental level; encouraging immigrants to cross the border illegally and then rewarding them when they have a child here by making said baby an instant-citizen and therefore accorded all the rights and privileges afforded Americans; including welfare payments. Perhaps even more potent is their right, once they turn 18, to petition for their immigrant family members to stay in the United States. Thus these babies are far more than euphemistic anchors: they are quite literally paychecks and a membership card into the network of social services offered in America. This powerful dynamic is now pervasive across the nation, resulting in chaotic scenes as American citizens demand enforcement of immigrations laws while immigrants and their advocacy networks decry any effort to deport those here illegally.”

 

[chraland51]

An ex-wife worked in community east's emergency room. She said that the races of the patients were pretty evenly divided based on her observations. Where the differences showed up was who had insurance and who did not. I will let you guess at the two races that mostly did not have insurance and demanded FREE care for everything from colds to actual emergencies.

My son is a paramedic/fireman in West Palm Beach. I do not know what the breakdown in races is for his district, but the number of non-white people demanding a free ride to the local hospital emergency room for any ailment based on their possessing a medicade card really puts a strain on those of us who are fortunate enough to be working and paying for our own health insurance. West Palm Beach is also providing free computers/internet access and probably free cell phones to their low income populations while my son and I pay a fortune for the privilege of having those luxuries for ourselves. Something just doen not seem right with these pictures!!! Go bammer and all those like him who came before him!!!!!

 

[jsharmon7]

I work in a hospital and while I don't spend much time in the ER I will say that the results of the survey tend to reflect what I'm seeing. Unfortunately the majority of the ER visits are for trivial crap they should see their family doctor for or man up, take a couple of tylenol and get over it.

Amen to that. If I had a nickel for every person who comes into our ED with some piddly crap (toothache, upset stomache, common cold, had a cough for 4 days, etc) I could retire already. There are family doctors and immediate care centers for these situations, the ED is for...emergencies. I guess they keep us in business and money coming in for the hospital, so I shouldn't complain.

 

[antsi]

I guess they keep us in business and money coming in for the hospital, so I shouldn't complain.

Yeah, except it isn't their money. It's tax money. Which means your money and my money.

Worse yet, accumulating federal debt so it's really our kids' money. My son is only 4 years old and he's already $275,000 in debt.

 

[smoking357]

We often hear it said that Hispanics are disproportionally overusing services at ER's and that this is leading to a breakdown of some sort in the welfare system. Well, according to the CDC, that's just not true. The leading users of ER's are old people, blacks and the poor. Whites use the ER more often, than hispanics. This, like the hispanic crime wave nonsense, is no more than a base canard.

If you're trying to deceive the public, you need a group to demonize.

 

[antsi]

If you're trying to deceive the public, you need a group to demonize.

Or, alternately, make them into hapless victims in need of protection.

 

[E5RANGER375]

well i guess this means we need start giving illegals more reason to need to visit the ER.

 

[88GT]

If US citizens used perinatal care like illegals do, and had their same outcomes, our perinatal health care costs would be a fraction of what they are.

Thread jack....

I'm a doula and soon to be certified child birth educator, as well as having the pleasure of experiencing both a surgical birth and subsequent VBAC (the latter at 9lbs10oz). I advocate strongly (and that's an understatement) for minimal interventions and the least amount of medicalization required for any give pregnancy. The one thing I've learned is that until you convince women that birth isn't a medical issue and OBs are not necessarily making decisions in the mom or baby's best interest, it will never change.

I'd also argue that the choice to perform a cesarean is largely based on the form of payment. Those iwhose ability to pay is in question will be given a cesarean as a last resort because of the increased cost and the greater risk with not being paid for it. But those with insurance are almost forced into it because it's a greater CYA choice for the OB (from a lawsuit standpoint, not at all true when it comes to risk to mother and child) and it's more money in OB's pocket for less time. There is absolutely no incentive for an OB to catch at a vaginal delivery for a third-party guaranteed payment anymore. The same can be said for all those unnecessary pre-natal screenings and tests. Don't even get me started on the GD and GBS crap.

I know that has little to do with the topic at hand, but it's a subject near and dear to my heart.

Now back to your regularly scheduled discussion.