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Study: No insurance means no aftercare

CHICAGO - It's not how sick you are but whether you have health insurance that often determines how quickly you can get urgently needed followup care after emergency room treatment, a study has found.

Private insurance gives patients a far better chance of getting appointments within a week of treatment than does Medicaid or no insurance, according to the study of 430 clinics in nine U.S. cities. Most clinics inquired about patients' insurance status but not their conditions, the researchers found.

The findings shatter the myth that "when people really need care, they get it," said lead author Brent Asplin, head of emergency medicine at Regions Hospital in St. Paul, Minn. Delays in urgent outpatient treatment put patients at risk for life-threatening conditions, he said.

But even privately insured Americans - about 180-million - are at risk, according to the study, which found that private insurance wasn't a guarantee of timely access.

Co-author Karin Rhodes, an emergency physician at the University of Chicago, said she fairly frequently sees patients return to the emergency room in a deteriorated condition because they didn't receive timely followup care.

"I don't think that's saving our system money," Rhodes said. "The disaster following (Hurricane) Katrina demonstrates that it's a real mistake not to take care of the poor."

About 45.8-million Americans are uninsured and 53-million others are covered by Medicaid, the government-funded program for low-income people.

The inequity found in the study "is a disgrace," said Carmela Coyle, senior vice president for policy at the American Hospital Association.

"As a nation, we've got to find a way to provide coverage for everybody, not just those who are employed" or able to pay for private insurance, Coyle said.

The study, appearing in this week's Journal of the American Medical Association, comes amid growing pressure to avoid hospitalizing all but the sickest patients treated in emergency rooms - a strategy that depends on timely access to followup care, the researchers said.

"We weren't trying to point out any villains in the system - clinics certainly need to make sure they can cover the cost of their care," Asplin said.

The researchers had graduate students pose as patients treated in emergency rooms for pneumonia, rising high blood pressure or suspected tubal pregnancies.

Students called clinics saying they had been treated the previous night and had been urged to obtain followup care as soon as possible.

Each student posed once as a patient with private insurance and secondly as someone with Medicaid or no insurance.

"Privately insured" callers were much more likely to get timely appointments than were those posing as Medicaid patients - nearly 64 percent versus 34 percent - and than those posing as uninsured patients - 65 percent vs. 25 percent.

Only 28 percent of clinics attempted to determine how sick the callers were, while 98 percent inquired about their insurance status.

Besides ability to pay, reasons for the disparity might include data showing that the uninsured and Medicaid patients are less likely to show up for appointments - perhaps because they might have more restrictive jobs or less access to transportation, said Lisa Gregory of the Illinois Primary Health Care Association, a trade group for community health centers across the state.

[Last modified September 14, 2005, 02:15:34]