Don’t Blame it on the Immigrants; It’s Grandma’s Fault

A study released today by the health care policy journal Health Affairs points to a surprising new culprit in the overuse of hospital emergency departments-Medicare patients. The report conducted by the Center for Studying Health System Change, What Accounts For Differences In The Use Of Hospital Emergency Departments Across U.S. Communities? [PDF] defies the conventional wisdom of blaming illegal immigrants and the uninsured for overcrowding emergency rooms across the country.

In fact, the survey of 46,600 people residing in 60 representative communities throughout the United States, notes that communities have high rates of per person [Emergency Department] ED use in part because they have fewer, rather than greater, numbers of Hispanics and noncitizens.

Insurance, demographic, socioeconomic, and health factors are strongly related to individuals  ED use, although some of these results run contrary to popular perceptions. For example, in 2003, the uninsured had about sixteen fewer visits on average (per 100 people) compared to Medicaid enrollees, about twenty fewer visits compared to Medicare enrollees, and roughly similar levels of use compared to privately insured people (Exhibit 3). Noncitizens had much lower levels of ED use than citizens did (about 17 fewer visits per 100 people, on average), and the difference between poor citizens and noncitizens was almost twice as large. In terms of racial/ethnic differences, blacks had higher ED use levels than whites and Hispanics did in 2003. More in line with expectations was the higher ED use by poor people (less than 100 percent of poverty) compared to other income groups, and higher ED use by people in fair/poor health and with chronic medical conditions.

While Colorado legislators debated and passed stringent new laws prohibiting illegal immigrants from receiving certain state services during the Special Session earlier this month, the facts belie the rhetoric as it pertains to healthcare. Perhaps Governor Owens and the General Assembly should consider the implications of Colorado’s high ranking in the best places in the country to retire:

High levels of ED use among Medicare beneficiaries and Medicaid enrollees are a potential source of increases in ED visit rates in the future. The aging of the population and retirement of the baby-boom generation will greatly  increase Medicare enrollment and the proportion of  the population who are elderly, who tend to have  higher levels of ED use compared to other age groups.

Who wants to tell Grandma to pack it up and move back to Cleveland?

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