Every single person living in California has access to care—the 6.5 million uninsured simply get theirs in our emergency rooms, the single most expensive place to see a doctor. Last year, 27 hospitals in San Diego County reported losing $620 million in uncompensated care. At Scripps Mercy, the uncompensated care total was almost $50 million. The Governor’s comprehensive health care reforms address this broken system.
The Governor’s comprehensive health care reforms get Californians out of emergency rooms and into their doctor’s office.
- Under the Governor’s reforms, every Californian will be required to have health coverage (“individual mandate”), and everyone will be able to obtain a health insurance policy in the individual market (“guarantee issue”).
- This means that those who need emergency care will have insurance to cover it—and that Californians can get treated in less costly venues, such as doctor’s offices or clinics.
- The Governor’s reforms also support preventative care programs, like obesity reduction and smoking cessation, to reduce chronic disease and emergency care costs.
- U.S. Health and Human Services confirms that $3.45 billion in new federal funds are available for the Governor’s proposal. $2.2 billion will go to increase Medi-Cal reimbursement rates. This money will compensate hospitals and doctors for treating Medi-Cal patients—reducing their reliance on emergency care and increasing their access to primary care.
The Governor’s reforms reduce emergency room misuse and over-use, lowering costs for everyone.
- Getting treated in an emergency room is 3-4 times more expensive than a trip to the doctor’s office, according to the California Health care Foundation.
- When hospitals provide emergency care to uninsured Californians, they absorb millions in uncompensated costs. They must recover that money, meaning everyone’s costs go up. Tens of millions of insured Californians—and employers—pay a hidden tax, in the form of higher insurance premiums, higher deductibles, co-pays, and out-of-pocket expenses.
- Guarantee issue, paired with the individual mandate and Medi-Cal rate increases, reduces the hidden tax, estimated at $455/individual and $1,186/family annually. The hidden tax is equal to about 17 percent of all health care expenditures, and costs employers approximately $14 billion each year.
The Governor’s reforms help emergency room doors stay open, ensuring Californians’ access to critical trauma care.
- According to the Office of Statewide Health Planning and Development, 65 California emergency rooms have closed in the last decade. In Los Angeles County alone, 20 percent of ERs have closed since 1995.
- A new study by the federal Centers for Disease Control and Prevention shows that between 40-50 percent of emergency departments experienced overcrowding in 2003 and 2004. According to the study, the uninsured and Medi-Cal patients are the major causes of this overcrowding, especially in metropolitan areas.
- The result: longer drives to fewer ER facilities, longer waiting times, and compromised hospital capacity to cope with a major emergency.
Just the Facts
California hospitals shouldered more than $5 billion for uncompensated care in 2003. "Providing uncompensated care to the 7 million uninsured Californians only adds to the relentless and increasing financial pressures on hospitals. In 2003 alone, California hospitals provided more than $5 billion in uncompensated care (adjusted for cost) to low-income and uninsured patients." Source: "California Hospitals’ Financial Condition: On Life Support," California Health Care Association, June 2004.
Almost half of ER patients believe that their problem could have been handled by their own doctor. “46 percent of all ER users believed that their problem could have been handled by a primary care physician, had one been available. Furthermore, one in five recent ER visits can be defined as avoidable. An avoidable ER visit is one that occurs during weekday business hours and was for a problem that could have been treated by a PCP or could have waited longer than 24 hours to treat.” Source: “Overuse of Emergency Departments Among Insured Californians,” California Health Care Foundation, October 2006.
Crowded ERs reduce treatment quality: pneumonia patients
A study by researchers at UCSF found that “…Emergency Department (ED) crowding and higher ED complexity are associated with poorer quality of care for admitted pneumonia patients. As ED volume and number of patients requiring admission increased; odds of patients receiving antibiotics in less than 4 hours decreased.” Source: “Impact of Emergency Department Crowding on Door to Antibiotic Timing in Admitted Patients with Community-acquired Pneumonia,” Academic Emergency Medicine, May 2006, Vol. 13, No. 5.
Crowded ERs reduce treatment quality: cardiac patients
“One recent study of heart attack patients found that Emergency Room overcrowding delayed the administration of live-saving medications, resulting in quantifiable increases in mortality.” Source: “Don’t Bring Me Your Tired, Your Poor: The Crowded State of America’s Emergency Departments,” National Health Policy Forum, George Washington University, July 7, 2006.
ER overcrowding leads to boarding, relocating patients. “In a nationwide survey of nearly 90 Emergency Departments across the country… 73 percent reported boarding two or more patients a day. Boarding not only compromises the patient’s hospital experience, but also adds to an already stressful work environment for physicians and nurses, and enhances the potential for errors, delays in treatment, and diminished quality of care.” Source: “Hospital-Based Emergency Care: At the Breaking Point,” Institute of Medicine of the National Academy of Sciences, June 14, 2006.
Emergency visits cost three times more than a normal outpatient visit. According to a study of Emergency Departments in California, the average cost (in 1998 dollars) for an ER outpatient visit was $350, more than three times as much as the cost of a normal outpatient visit. Furthermore, the average cost of ER outpatient care does not decline as the number of patients increases. Source: “Marginal Costs of Emergency Department Outpatient Visits: An update using California data,” USC Center for Health Financing, Policy, and Management, November 2005.
The uninsured are more than five times more likely to use ER for primary care. “About 20 percent of the uninsured (vs. 3 percent of those with coverage) say their usual source of care is the emergency room.” Source: “The Uninsured: A Primer, Key Facts about Americans without Health Insurance,” The Henry J. Kaiser Family Foundation, October 2006.
The uninsured are more likely to be hospitalized for an avoidable condition. “Nationally, the uninsured are 30 to 50 percent more likely to be hospitalized for an avoidable condition, with the average cost of an avoidable hospital stayed estimated to be about $3,300” Source: “Hidden Costs, Values Lost: Uninsurance in America,” Institute of Medicine, June 2003.