The number of uninsured Americans 0-64 years old has increased to 46 million, and has increased from 9.3% of the population in 1994 to 17.5% in 2007. Theses patients have had increasingly difficult times finding medical care. Their situation has only been worsened by the weakened economy. A survey by the Center for Nonprofit Advancement confirms that nonprofit organizations across the greater Washington region were experiencing an increase in demand for services while funding continued to decrease. This unfortunate circumstance is not unique to Washington but prevalent across the entire United States.
I saw a patient the other night in the emergency department who had recently been discharged from the hospital with pneumonia. She was told to get a recheck with her regular doctor in 2-3 days. Unfortunately she had recently been laid off and lost her health insurance coverage not being able to afford her COBRA premium. She was eligible and signed up for Medicaid but after calling almost 20 physicians she could not find a doctor to see her for the follow-up appointment. Without any other resources she came to the emergency department complaining of persistent cough and shortness of breath. A repeat chest x-ray was done to ensure she did not have a worsening lung infection, and measurement of her oxygen status revealed that she was breathing adequately. I reassured her it would take a few more days before she felt significantly better, and she was thankful for the care she received. She asked me if I knew of any clinics that were accepting Medicaid patients. Unfortunately the only clinics accepting Medicaid patients did not have any available appointments for 3-4 weeks. We gave her referrals and made sure she understood she could return if her recovery took a relapse.
The above situation is not one unique to my practice. Any emergency physician can tell you the same story many times over. An estimate of the cost of her care in the emergency department that night would total over $1,000, while her care in an urgent care clinic or primary care clinic would be approximately $200. Our health care system cannot withstand the economic lunacy of continuing to see patients in the most expensive setting. The emergency department resources are being pushed to the brink and will not be able to withstand the surge of patients if more continue to lose their safety net of insurance. We must provide our uninsured and under-insured citizens with a more appropriate and less costly choice for medical care.