Why are the Insured Crowding ERs?

Emergency departments (EDs) are almost always overcrowded and a new study sheds some light on the who, the how and the why. The increased number of visits from the mid '90s to now are in fact coming from insured patients who have access to a usual source of care (PCPs)! Visits by the uninsured, who would normally be considered the more likely culprits, have actually stayed stable in the past decade.

This is really important on the policy end, considering universal health care (if enacted) may exacerbate, not reduce the ED overcrowding problem. Also, if the uninsured aren't the main concern behind this issue, safety net funding for bad debt may take a hit.

But back to why the insured might be responsible for more visits in the ED. The authors say the

"increase in ED use may be attributable to lack of ready access to primary care and other structural problems in the health care system."

Structural problems such as long waiting times for appointments, lack of relevant patient info such as medications and prior medical/surgical history, sub-par diagnostic and treatment capabilities, and poor post-visit communication between patient and their PCP. This is really disconcerting since EDs are being filled up with patients who have minor complaints or illnesses, thereby diluting triage meant to prioritize those with urgent needs.

Looks like there's a lot of work cut out for all of us in health care.

EDIT: In regards to Di G.'s comment about clarifying how insured patient's actually wind up in the ED, here's one elaboration. Say you're experiencing horrible stomach pain and your PCP is out of town. You go to another doc to get a referral for a GI specialist. The new doc has no history of your prior history of bulimia or the gall bladder operation you had a couple years back and now neither does the GI guy. The GI doc, unaware of the lack of your medical information, sees you and when you're prompted to provide information about the meds you're on, you have no idea and start listing the colors of the rainbow you see every morning in your pill box. Your prior history is incomplete, you don't know what meds you're really on, and you're pretty high on the pain scale. You're an easy triage to the emergency department regardless of who sees you. But in the ED, the triage nurse will most likely put you towards the bottom of the list after the gun shot wounds and car accident patients. Hence, the 4 hour wait.

Electronic records are just one part of the solution. More importantly the flow of information from one site to another is the key to making this all work. The VA does it well, but most other clinics use different vendors that don't talk to each other.