Introduction
In the United States, if you show up at the emergency room you can see a doctor, regardless of your ability to pay. This right is protected by the Emergency Medical Treatment And Labor Act (EMTALA), passed by Congress in 1986 (Terp et al., 2016). This act was in response to the large number of critically-ill patients who were being turned away from emergency rooms because of the economic status. Today, the purpose of EMTALA is still to prevent emergency rooms from “patient dumping”, or turning away critically-ill patients because they are uninsured (Rosenbaum, Cartwright-Smith, Hirsch, & Mehler 2012). EMTALA requires that every patient who arrives at the emergency room is given an initial screening, is treated until stabilized, and has the right to be transferred to a hospital with the correct level of care for their condition, regardless of their ability to pay (Rosenbaum et al., 2012).
However, most of America has also experienced the overcrowding of emergency rooms and have personally experienced the long wait times. Though no research finds a direct cause between EMTALA and overcrowding, long wait times are inevitably discussed any time the EMTALA policy is brought up. However, it certainly does not help that the U.S. has 45 million uninsured individuals who do not have access to primary care and are forced to turn to the emergency department for any kind of medical attention (Monga, Keller, & Venters, 2014). Additionally, of
looking at mortality rates in patients seeking emergency care conclude that the rate of death is substantially higher during times of crowding (Richardson, 2006, p. 213).
A visit to the emergency department (ED) is usually associated with negative thoughts by most people. It creates preconceived images of overcrowded waiting rooms and routine long waits for treatment (Jarousse, 2011). From 1996 to 2006, ED visits increased annually from 90.3 million to 119.2 million (32% increase). During this same time period, the number of EDs has declined by 186 facilities creating the age old lower supply and greater demand concept (Crane & Noon, 2011). There are many contributing factors that have led to an increase in ED visits. A few of these key drivers include lack of primary care access, rising of the uninsured population, dwindling mental health services, and the growing elderly
Since the development of the EMTALA Act in 1986, any individual which presents to the emergency department, must be accessed and triaged by qualified medical personnel. (www.cms.gov) Individuals are aware that if they present to the emergency department, regardless if it is for just a tooth ache or a major illness like a heart attack, they will have to be treated. “This mandate does not extend to private physician offices, however, which creates an incentive for those without the means to pay for care to
The lack of health insurance reached began to become a serious issue in the mid-1990’s reaching a crisis level in the 2000’s. Individuals without insurance turned to emergency rooms across the country to obtain care routine care, turning emergency departments into primary care facilities. In many instances, people who presented at emergency rooms for treatment could not be turned away due to various health and safety regulations; therefore, patients were seen without the ability to pay often leaving the hospitals with millions of dollars in uncollectable debt, subsequently leading to the insolvency of hundreds of hospitals across the United States.
In 1986, the Emergency Medical Treatment and Labor Act (EMTALA) was enacted. The federal government enacted the law to provide everyone with access to emergency medical care, even for those unable to pay. EMTALA declared that any individual who enters a “qualifying hospital” is entitled to an “appropriate” medical examination to determine if an “emergency medical condition” is present. The individual cannot be “transferred” until the “emergency medical condition” is “stabilized.” Only if the individual cannot be “stabilized,” an “appropriate transfer” may be performed. Hospitals must accept
The implications and effects on patients waiting long hours to be seen in the ED are immense. In a recent study done over five years in Ontario hospitals showed the risk of adverse events and even deaths increased with the length of stay in the ED (Science Daily, 2011). When EDs become overcrowded the quality of care changes and declines; which is extremely dangerous. Authors of the study calculated that if ED length of stay was cut by only an hour that 150 fewer Ontarians would die each year (Science Daily, 2011). Wait times can also negatively affect patients financially, untreated medical conditions can lead to reduced productivity and inability to work leading to increased financial strains (Fraser Institute, 2014). As well as delayed access to care can result in more complex interventions needed. Therefore an initiative is needed to provide patients with timely, efficient care when accessing
The new federal health-care law has raised the stakes for hospitals and schools already struggling to train more doctors. Evidence suggests there won’t be enough number of doctors to treat the newly insured millions under the ACA. At current graduation and training rates, America faces a shortage of as many as 150,000 doctors in the next 15 years, according to the Association of American Medical Colleges. The greatest demand will be for primary-care physicians. Emergency rooms, the only choice for patients who can't find care elsewhere, may grow even more with longer wait times under the new health law. That might come as a surprise to those who thought getting 32 million more people covered by health insurance would ease ER
Many uninsured and underinsured focus group participants described going to emergency departments for non‐urgent care because they could not afford to pay for private care and knew they would not have to pay the emergency department charges and/or preferred to be seen as soon as possible. Several informants mentioned that the emergency department becomes a default source of primary care, which is costly and lacks the continuity of care that chronic conditions demand ("Community Health Needs Assessment,"
EMTALA is the Emergency Medical Treatment and Labor Act that was developed in 1985 as part of the Title IX of the Consolidated Omnibus Budget Reconciliation Act that went into effect in the year 1986 (Sara Rosenbaum, 2012). EMTALA was developed after an article was published in 1986 that documented how Cook County Hospital in Chicago was receiving patients that were “dumped” there that were unemployed, minorities, and lacked health insurance (Singer, 2014). This problem also occurred in 1983 in Dallas where over 200 patients were transferred between hospitals that were not stable (Singer, 2014). EMTALA is under the direction of the Department of Health and Human Services and was developed to address the needs of Americans
Emergency room over utilization is one of the leading causes of today’s ever increasing healthcare costs. The majority of the patients seen in emergency rooms across the nation are Medicaid recipients, for non-emergent reasons. The federal government initiated Medicaid Managed Care programs to offer better healthcare delivery, adequately compensate providers and reduce healthcare costs. Has Medicaid Managed Care addressed the issues and solved the problem? The answer is ‘Yes’ and ‘No’.
The rising costs of unpaid emergency room expenditures were an issue that had to be addressed by state authorities. EMTALA required that all persons be treated, however, it did not include any legislation to reimburse payment that left hospital left with unpaid bills and growing expenses.
Because of the EMTALA, therefore, much more than emergency room care is provided regardless of ability to pay” (Menzel, 2011, p. 84).
Tang N, Stein J, Hsia RY et al: Trends and characteristics and US emergency department visits, 1997 – 2007. JAMA 2010; 304: 664-670
With many living in poverty and on unemployment whether by choice or due to lack of insurance, the crime rates rise also leading to risky behaviors. These risky behaviors sometimes end up leading to the emergency room settings. This increases the cost of health care with no primary care physician available.
A man sits at home among bottles of whiskey, antiseptic wash, and bandages. He has a sewing needle and thread in his hand and is about to attempt to stitch up a large open wound on his forearm. Why would a man perform medical help on himself? Why would a man with a serious injury not go to the hospital to receive medical attention? The answer is very simple he has no medical insurance. The average cost for visiting the emergency room is 1,233 dollars which is 40 percent more than the average income person spends on rent. (Onion, 2014) A report released by the Census Bureau estimated that in the year 2013 the number of uninsured people living in the US equaled 42 million. Nearly one third of America’s population is uninsured or has inadequate health insurance.