Most ER Patients Are Insured, Study Says

The finding suggests that expanding health coverage will not by itself significantly help emergency rooms cope with demands that include patients seeking care for routine problems such as colds or sinus infections, experts said.

The uninsured account for just 15% of emergency-room visits, according to the study to be published today by the American College of Emergency Physicians. The nonprofit organization advocates for the interests of emergency-room doctors and supports medical research.

Emergency rooms are crowded because they fill up with patients who cannot get in to see their own doctor or are waiting for regular hospital beds, experts said.

"We've cut hospital budgets so much, the only way they can be efficient is by operating as close to capacity as possible, like airlines," said Sandra Schneider, head of the emergency medicine department at the University of Rochester in New York.

The study confirms earlier findings that have begun to change scholarly thinking about the cause of emergency room crowding.

Healthcare providers assumed until recently that uninsured patients were the primary cause of crowding, said Diane Jacobsen, a director at the Institute for Healthcare Improvement in Cambridge, Mass., who did not participate in the study. Most doctors are free to turn away patients who cannot pay, but emergency-room doctors must see everyone.

Over the years, however, research has indicated that the problem is broader and more complex. "We often focus on the ER as the problem, when the ER is a symptom of the problem," Jacobsen said.

The study was conducted by researchers with the Robert Wood Johnson Foundation and UC San Francisco. They studied survey responses given by 32,669 households across the country in 2001. The researchers estimated that about 45 million American adults made a total of 80 million visits to emergency rooms between July 2000 and June 2001.

Frequent emergency-room users -- those who visited emergency departments four or more times a year -- represented less than a tenth of all emergency users yet accounted for 28% of all visits, the study found.