Native-born, insured patients fill Calif. hospital ERs, study says

It's not the uninsured. It's not illegal immigrants.The Californians most likely to crowd hospital emergency rooms -- often with fevers or infections that could be treated elsewhere -- are insured by the government and born in the United States, according to a new statewide study.For every 100 people on the state Medi-Cal rolls, 47 visits were made to emergency rooms in 2005, according to the Public Policy Institute of California. For every 100 people covered by Medicare, 46 visits were made to ERs. Californians without any insurance made 31 visits for every 100 people.The report also challenged the perception that illegal immigrants are more likely to use the emergency room as a doctor's office, taking advantage of the federal law that compels the staff to treat anyone who walks in the door. It said about 12 percent of non-citizens reported they were likely to use an emergency room in 2005, compared to about 14 percent of people born in the United States.Experts debate how much the trends contribute to the crowding of hospital ERs in California. In Ventura County, for example, the facilities are already so packed that ambulances were diverted from different hospitals for 7,400 hours last year, the equivalent of 308 days.Others worry about increasing the financial burdens on hospitals that have closed some 70 emergency rooms in the state in the past decade.People on Medi-Cal are also the group most likely to use the emergency room for routine conditions that could be treated in a doctor's office or clinic, according to the Public Policy Institute report. It said about 44 percent of all California emergency room visits in 2005 could have been seen outside the ER.Some physicians think the trends are on the upswing, with emergency rooms continuing to see more insured people who can't get doctor's appointments. And it won't just be people covered by Medi-Cal and Medicare, said Dr. Jim Hornstein, a Ventura County family doctor."The bottom line is they're the canary in the mine shaft," Hornstein said. "They're the first ones who can't get in."Hornstein points an accusing finger at a primary care doctor shortage created in part by the reality that specialists make more money. Practices for existing family care and internal care doctors are jam-packed with patients. Anyone new has trouble getting in the door.The shortage has hit Medi-Cal beneficiaries first because of money. Fewer than half of the state's doctors accept Medi-Cal because the reimbursement rate is so low, according to the California Medical Association."I'd have gone broke a long time ago if I took Medi-Cal," said Dr. Ted Hole, another Ventura family practice doctor. "They pay maybe $20 for an office visit. My overhead per visit is $40. How can you do that?"Hole said private insurance companies also don't pay doctors enough to motivate them to see patients on weekends. He said doctors get paid the same whether they see patients or refer them to the ER.So they send them to the hospital.Doctors want to provide the best care they can for patients, Hole said. But like people in every other profession, they are also trying to make a living."There is no aspect of medicine that is not somehow related to reimbursement," he said. Hospitals are barred by law from asking emergency room patients about immigration status. Public Policy Institute researchers acknowledged the population's healthcare visits are hard to track.Still, they used the California Health Interview Survey to conclude that a greater percentage of people born in the United States were likely to use the emergency room than are naturalized citizens. Both groups were more likely to rely on emergency care than non-citizens."Are immigrants going to the emergency room? Yes. Are they going at a higher rate than others? No," said the study's co- author, Shannon McConville.Some observers argue that illegal immigrants rely on community clinics and live in secrecy, worried that any public exposure could result in deportation."People who are desperately poor and come from a very different culture and speak a language that no one else speaks are very wary of authority figures in any setting," said Susan Haverland, leader of an outreach program that works with Mexican farmworkers who speak the indigenous language of Mixtecan.(Tom Kisken is a reporter for the Ventura County Star in California.)