Remember when I wrote, way back when, that expanding health coverage without a concurrent increase in primary care access will only worsen emergency room waits?
For instance, consider this, from CNN.com:
What good is having health insurance if you can’t find a doctor to see you? …
… The Massachusetts Medical Society reported that the average wait time for a new patient looking for a primary care doctor ranged from 36 to 50 days, with almost half of internal medicine physicians closing their doors entirely to new patients. And when you consider that Massachusetts already has the highest concentration of doctors nationwide, wait times will likely be worse in other, less physician-abundant parts of the country, should universal coverage be enacted federally.
When patients are forced to wait weeks to obtain medical care, they inevitably find their way into the emergency department for treatment that ordinarily can be handled in a doctor’s office.
That was written in August 2009. Turns out it was pretty prescient.
I read two articles recently that confirms this reality. The first was from the Boston Globe. In Massachusetts, emergency room visits rose by 9 percent from 2004 to 2008, to about 3 million visits a year. One reason? Expanded coverage:
According to a report from the Division of Health Care Finance and Policy, expanded coverage may have contributed to the rise in emergency room visits, as newly insured residents entered the health care system and could not find a primary care doctor or get a last-minute appointment with their physician.
David Morales, commissioner of the division, said several national and statewide studies have shown that expanding insurance coverage does not reduce emergency room visits.
The next day, the Associated Press came out with a similar piece, with a nationwide perspective. It’s not surprising that the country is looking at Massachusetts to forecast national health reform’s effects. And it doesn’t look good for emergency rooms:
Rand Corp. researcher Dr. Arthur L. Kellermann predicts this from the new law: “More people will have coverage and will be less afraid to go to the emergency department if they’re sick or hurt and have nowhere else to go…. We just don’t have other places in the system for these folks to go.”
Kellermann and other experts point to Massachusetts, the model for federal health overhaul where a 2006 law requires insurance for almost everyone. Reports from the state find ER visits continuing to rise since the law passed — contrary to hopes of its backers who reasoned that expanding coverage would give many people access to doctors offices.
I’m on record with supporting health reform, and expanding coverage. I simply don’t think it’s acceptable to have tens of millions of Americans without health insurance. But we have to be cognizant of the unintended consequences if primary care continues it’s disastrous decline.
It will take significantly more than what’s included in the The Patient Protection and Affordable Care Act to convince medical students to go into the field, and prevent current primary care doctors from leaving. And to those who say physician assistants and nurse practitioners are the answer, they’re not. First, there’s simply not enough of them to meet the demand, and second, the lucrative allure of specialty practice is also drawing mid-levels away from primary care.
Unless drastic measures are taken soon, the emergency room will surely be the next domino to fall as more than 30 million newly insured patients are set to further strain our health system.
Kevin Pho is an internal medicine physician and on the Board of Contributors at USA Today. He is founder and editor of KevinMD.com, also on Facebook, Twitter, Google+, and LinkedIn.
