Nine Texans, 2,678 emergency room visits: Should we ration health care?

A recent study by the Integrated Care Collaboration (ICC) of emergency room visits in Central Texas discovered that, over the past six years, nine individuals have made 2,678 ER visits to local hospitals, at a cost of $3 million. One of these people visited 145 times last year and 554 times in the past five years.

Reading these stats reinforces my conviction that any unified national health care program will have to include that ugly word, rationing. Nine people should not be able to run up a $3 million tab when so many others lack basic services such as vaccines and prenatal care.

These nine are the poster people for wretched excess, but the problem of people using the ER as a clinic for non-emergency complaints is widespread. According to a CDC study, of the 119.2 million ER visits in 2006, only 15.9 million could be classified as true emergencies. A staggering 11 percent of all non-emergency medical care visits in the U.S. now take place in the ER rather than doctor's offices or clinics.

Anjum Khurship, Director of ICC's Clinical Research and Evaluation, estimates each ER visits costs Central Texas hospitals around $1,000. According to the CDC, 17.3% of all ER visitors are uninsured, while only 21 percent have private insurance. Eighty-two percent have Medicaid or SCHIP, while 48 percent are eligible for Medicare coverage. The American Hospital Association reports that U.S. hospitals lost $34 billion in 2007 to bad debt and charity cases.

The Texas nine are middle-aged, some men, some women. Seven have mental diagnoses, while eight have a history of drug abuse. Nationally, homeless are the second highest population of ER visitors (behind infants) with 83.6 visits per 100 homeless people. 36.1 white people per 100 visited the ER in 2006, compared to 79.9 per 100 black people and 35.3 Hispanic people. These figures, I would guess, reflect the difference in household income by race in the U.S.

Who pays for the ER visits when the patient can't? You, of course. Who else? Some is your tax money strained through Washington, while some is buried in the cost of your hospital visits. No matter how health care is apportioned, there will be those like these nine who obsessively abuse the system. A relative handful of such people could drive the cost of unlimited health care into the stratosphere. Perhaps, before we figure out how to pay for everyone's medical needs, we should find a way to avoid wasting another $3 million on excessive ER visits.

It's not that I lack compassion for the Texas nine, but after 2,678 trips to the ER, I can't believe the system is working for them OR the hospitals. At some point, we're going to have to add a new tool to the medical system -- the word "no."

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