It’s 10 a.m. in the Hennepin County Medical Center emergency room and the wait is already an hour. The waiting room is filled with people in varying degrees of need of care, and they all look tired.
Tired of waiting. Tired because of illness. Tired because the emergency room is an exhausting place. Triage nurses are working to make sure the most urgent cases are seen as soon as possible. If the rest see a doctor in an hour, they’re the lucky ones. The national average waiting time in an emergency room is more than three hours, with some places creeping closer to five hours. The reason? People using the emergency room for primary care.
This is the third in a “Uninsured and Unsure in Minnesota,” a series on going without health care. Read the first two articles at Uninsured and unsure in Minnesota: The Pessimistic Optimist and The $18 Doughnut.
At HCMC, folks who frequently visit the ER are called “special needs” patients. Some are homeless and have no access to regular care. Some are transient, recent immigrants and the newly jobless. The one thing they have in common is a lack of health insurance. And that lack of insurance can cost hospitals dearly.
“People believe we are a free place, and that’s just not true,” says Mavis Miller, a registered nurse in charge of the special needs population at HCMC. Her clients have no access to primary care, so her job includes getting the emergency room staff to think like primary care providers, identifying patients in real need, and monitoring those with chronic conditions. Miller refers many patients to financial counselors who may connect them with appropriate public or private health coverage.
Despite these efforts, Miller still has between 1,200 and 1,500 active cases, she said.
Even those who are enrolled in coverage plans often have a hard time keeping up with the costs, which can include co-pays of up to $50. So many join the uninsured flocking to emergency rooms instead of retail-based clinics.
“People should have to pay for prescriptions, just not too much,” Miller said. “That $25 prescription can end up costing the hospital $4,000 if it was for something like an antibiotic that was unfilled.”
Government programs such as MinnesotaCare and Medical Assistance require annual enrollment, with daunting paperwork. You must have an address. You must have lived in Minnesota for six months and been uninsured for four months. Ten pages of application forms later, you may or may not be eligible.
So they just keep coming back to the emergency room, costing the hospitals dearly. In 2006 the cost of uncompensated hospital care in Minnesota was $206 million. And while the numbers have inched down over the past year, health care providers are worried that the weak economy will make the emergency room less and less about emergencies.
It can be frustrating for emergency room physicians and nurses who want to make a difference in people’s lives, Miller said.
Hospitals across the state are hurting because for many the ER is the only option for primary care. The millions hospitals absorb each year for uncompensated emergency room care could go a long way to improving the care all Minnesotans receive. If more folks could access MinnesotaCare’s $3-4 office co-pays and $1 prescriptions, the pressure on emergency rooms would ease and their doctors and nurses would be better able to provide the acute care they were trained for.
But last year’s $200 million MinnesotaCare surplus is still collecting dust. Meanwhile, each uninsured Minnesotan is just one illness away from costing the health care system substantially.
We need to open up MinnesotaCare and other state-funded programs and allow more access to the kind of cost-efficient, effective health care that most Minnesotans take for granted.