Ross Hunter's Profile

The dramatic increase in emergency department use during the past several years has been driven, in large part, by the chronic shortage of primary care physicians, according to a study in the Oct. 22 issue of the Journal of the American Medical Association, or JAMA.

ut it also concluded that overcrowding is directly tied to the declining number of primary care physicians, said Manya Newton, M.D., M.P.H., an emerg

he uninsured and people on Medicaid and Medicare use disproportionately more ER services than those who have private third-party coverage.

Low reimbursement rates for Medicaid recipients discourage physicians from providing services to this population. Thus, people on Medicaid frequently have no primary care provider and must rely on ERs for primary care services (McNamara et al., 1993; Nadel, 1993). While physicians can respond to monetary incentives in patient selection, ERs are required by law to evaluate every patient regardless of ability to pay. Emergency room co-payments are modest and are frequently waived if the patient is unable to pay (Kellerman, 1994). Thus, low out-of-pocket patient costs provide incentives for Medicaid patients and the uninsured to use ERs for primary care services (Gill, 1994; Padgett & Brodsky, 1992).