MIAMI – Contrary to popularly held ideas, a new survey of 60 communities shows that the uninsured, Hispanics and immigrants in general do not overburden hospital emergency rooms.
Previous studies of Hispanics and immigrants have shown they are more likely to be uninsured, and those without insurance are more likely to forgo primary care. That meant they would allow conditions to worsen and then end up in the ER with serious problems.
What’s more, foes of immigration often complain that newcomers place a huge burden on America’s healthcare system, unable to afford basic care and choosing instead the ER, where federal law insists everyone must be treated. The study cites in a footnote one such opinion, a 2003 article in the National Review: “Caring for Illegals, Losing Their Shirts: The Effect of the Wave on Border-State Medical Services.”
But after surveying 46,000 persons in 60 communities, author Peter J. Cunningham found that the highest ER usage was in Cleveland and Boston, cities with relatively low percentages of uninsured, Hispanics and immigrants.
“These are areas of large employers,” Cunningham said in an interview. “With a lot more union jobs, more private health insurance benefits and, at least in the case of Massachusetts, there’s also been a very strong tradition of public programs,” such as Medicaid.
Cunningham’s study, to be published Tuesday in the trade journal Health Affairs, focused on surveys by telephone and in person during 2003. He measured only ER visits that did not lead to hospital admissions, because he wanted to examine ER usage that might have been treated in doctors’ offices or urgent care centers.
Gerard Anderson, a Johns Hopkins professor who has done extensive studies of American health care, wrote in an e-mail Monday about the findings: “We know that uninsured people are more likely to use the hospital ER to receive care but we also know that they are much less likely to get care in the first place. It appears that not getting care is dominant.”
The key may be that the uninsured are concerned about hospital charges. Cunningham’s study found that those without coverage nationwide had 16 fewer visits per 100 people compared with Medicaid enrollees and about 20 fewer visits than seniors with Medicare.
Noncitizens had 17 fewer visits per 100 than citizens. Blacks were more likely than Hispanics to use ERs, perhaps because they are more likely to have some form of insurance, either private or public.
One reason for lower ER usage by immigrants could be that those without documentation might be afraid to go to a hospital, Cunningham said.
Another possible reason for varying ER rates could be that in some places, patients have a hard time getting an appointment with a doctor or a clinic and find it easier to walk into an ER, even though treatment there can be much more expensive.
Other studies have also found that immigrants tend to get less care. A University of California study last year found that recent immigrants from Mexico are half as likely to use ERs as are U.S.-born citizens. Another study, by Harvard Medical School, reported that children of immigrants get about 25 percent as much care as the kids of U.S.-born parents.
The latest study seems to indicate “there are no quick fixes,” said Cunningham. Many experts have suggested that getting everyone insured would solve all health care problems, but his work indicates that wouldn’t help control costs or over-utilization.
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