When the Massachusetts Legislature made health insurance mandatory five years ago, supporters of the first-in-the-nation law hoped it would keep patients out of hospital emergency rooms.
Patients with insurance, the theory went, would have better access to internists, family practitioners, and pediatricians, lessening their reliance on emergency rooms for routine care.
There is more evidence today that it did not turn out that way.
Three-quarters of Massachusetts emergency room physicians who responded to a survey last month said the number of patients in their ERs climbed in the last year.
They cited ''physician shortages'' along with a growing elderly population as the top two reasons why more patients come to ERs.
The law ''didn't create an infrastructure,'' said Dr. David John, chief of emergency care at Caritas Carney Hospital in Boston. "Doctors offices are full to capacity.''
The number of doctors who responded to the survey by the American College of Emergency Physicians -- 56 from this state -- is small. But their responses echo findings from last July, when state health officials found that ER visits rose 9 percent from 2004 to 2008, to about 3 million visits a year.
Nearly half of those patients could have been treated in a doctor's office, the state said, although the college doesn't believe the number is nearly that high. That's potentially 1.5 million people with sore throats, sprains, and the flu who didn't need expensive emergency care at all.
Solving emergency room crowding is clearly more complicated than many thought. Insurance coverage is just the first step. You need enough doctors to see the patients, and they must have room on their schedules for last-minute appointments, sometimes at inconvenient hours.
John said he saw one patient Wednesday with knee pain. "I asked him why he came to the ER. He said, 'My doctor gave me an appointment for May 26.' That's a month away!''
The 1,760 doctors nationally who answered the survey said diagnostic testing was the biggest expense in the ER. The main reason doctors order all these tests? Fear of lawsuits.
About white coat notes
|White Coat Notes covers the latest from the health care industry, hospitals, doctors offices, labs, insurers, and the corridors of government. Chelsea Conaboy previously covered health care for The Philadelphia Inquirer. Write her at firstname.lastname@example.org. Follow her on Twitter: @cconaboy.|
Gideon Gil, Health and Science Editor
Elizabeth Comeau, Senior Health Producer