Study shows declines in payment for emergency care

February 26, 2003

Payments for emergency care have declined substantially in recent years, according to a new study by a team of researchers from the Case Western Reserve University (CWRU) School of Medicine in Cleveland and Northwestern University Feinberg School of Medicine in Chicago. The study noted the most striking declines in payment among privately insured persons and concluded that "cost shifting" is an increasingly tenuous financing strategy to fund care for the uninsured.

"The study shows that only a little more than half of all emergency department charges are paid and that these payments continue to spiral downwards," said Rita K. Cydulka, M.D., one of the study's co-authors, who is an associate professor at CWRU and an emergency physician at MetroHealth Medical Center in Cleveland. "Declining payment rates increasingly threaten the ability of emergency departments to provide emergency care to all regardless of ability to pay."

Based on data from the Medical Expenditure Panel Survey, a nationally representative survey of the U.S. population conducted by the U.S. Agency for Healthcare Research and Quality (AHRQ), the researchers determined that, from 1996 to 1998, the rate of payment for emergency department charges declined from 60 percent to 53 percent.

The largest decline in payments was observed among the privately insured, whose payments decreased from 75 percent of charges to 63 percent. Payment rates by Medicaid, Medicare, and the uninsured remained relatively stable during this time period.

"Our findings question the common misperception that the uninsured are solely responsible for the financial crisis facing many emergency departments," said Alexander Tsai, a fourth-year CWRU medical student enrolled in the AHRQ-funded dual degree program in medicine and health services research and lead author of the study. "The good news for emergency departments is that, on the whole, the uninsured paid for a surprisingly large proportion of their bills. The bad news for everyone, however, is that the number of uninsured families in the U.S. is increasing."

Tsai conducted this study with the help of Joshua Tamayo-Sarver, also a CWRU medical student; Cydulka; and David Baker, M.D., of Northwestern. The researchers describe their findings in the paper "Declining Payments for Emergency Department Care, 1996-1998," published today in the Annals of Emergency Medicine.

The researchers tempered their conclusions somewhat because the data did not permit them to examine changes in the actual costs of providing emergency care. "We do know from previous studies that patients seeking emergency care are sicker than ever before and require more resources in the emergency department," said Cydulka, who is also a fellow of the American College of Emergency Physicians. "If this is the case, the declining overall payment rate suggests that the fiscal health of emergency departments is worsening."
The Annals of Emergency Medicine is a refereed publication of the American College of Emergency Physicians, the oldest and largest national medical specialty organization representing physicians who practice emergency medicine.

Case Western Reserve University

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