Clogging the Medical Turnstiles

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Can you believe that nine patients in the Austin, Texas-area used the emergency room 2,678 times over the past five years? This fact, reported by the Integrated Care Collaboration, is simply unbelievable until you consider that eight of the nine had a drug abuse problem, and were not doubt using the ER to make sure they had their fix of pain pills.

But this finding points to a larger problem; that our ERs are clogged, that they are often filled with patients for the wrong reasons, that ERs have a limited surge capacity in the event of a catastrophe. At a time when President Obama is considering expanding health coverage to all, the question is how to ease the overuse of ERs so more could be accomodated in a way that isn't so expensive.

Consider that an average ER visit costs the hospital between $500 and $1000. Consider that ERs are NOT filled with the uninsured. A 2008 study showed that ONLY 14 percent of ER visits involve patients without health insurance. More than 50 percent of visits (most often for minor complaints) are for people who earn more than four times poverty level, and that 29 percent of the people going to ERs are not only insured, they also have regular doctors. Doctors that they can't get in to see!

We have a growing shortage of doctors - especially primary care doctors. A Texas survey revealed that 60 percent of primary care doctors opted out of accepting Medicare last year. Approximately the same percentage of New York's primary care doctors are also dropping Medicare. The increasing number of doctors dropping insurance will lead to even more ER visits, as will expanding the number of patients who are covered by insurance.

Imagine what will happen if we decrease reimbursements to doctors (and hospitals) further. ERs will be flooded, and no one will get taken care of.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of "False Alarm: The Truth About the Epidemic of Fear"and "Bird Flu: Everything You Need to Know About the Next Pandemic." Read more at