Emergency room too costly for minor care (SC)

Greenville County residents who lack health insurance are turning to hospital emergency rooms in increasing numbers for non-emergency care. Patients are not turned away, and they shouldn't be, but ERs are expensive health-care facilities, and non-emergency visits drive up health-care costs for everyone. Those minor-care cases also place tremendous strains on ERs that already struggle to handle their emergency cases.

But the uninsured -- and underinsured -- have few other options when they're sick. Health-care officials believe the situation will only get worse as unemployment rises and more people lose health insurance.

The task for elected officials will be to find ways to expand the accessibility and affordability of primary care in South Carolina. Hospitals should use their considerable clout in this state to push for more options for low-income South Carolinians.

A recent community assessment found that more than a quarter of the visits to Greenville Memorial Hospital's emergency room this year have been for non-emergencies. At Bon Secours St. Francis Health System, it's is closer to 35 percent, hospital officials say. These conditions range from headaches and minor cuts to insect bites and sore throats.

The rising use of Greenville ERs for non-emergencies follows a nationwide trend. Not only are more uninsured residents using the ER but many Medicaid patients use the ER because they often have long waits for care in other settings. Many doctors are limiting the number of Medicaid patients they'll accept because of low Medicaid reimbursement rates for physicians.

The recent health assessment by the organization Greenville Forward found that 14.4 percent of Greenville County's population is uninsured, up from 10.6 percent in 2003. By far, the majority of the 65,500 uninsured residents are in working families.

To deal with increasing non-emergencies, Greenville hospitals use a variety of strategies, according to a recent Greenville News story. At St. Francis, for instance, all ER patients are screened for severity. The sickest are seen first. Non-urgent cases are typically seen by nurse practitioners who assess the condition and call a physician if needed. There's also a case manager who gives patients information about free clinics, community health centers and urgent-care centers.

Among other alternatives for the uninsured are local free medical clinics. But these facilities already are struggling to keep up with the need. More community health centers and low-cost clinics are needed in low-income neighborhoods.

Gov. Mark Sanford and state lawmakers could have strengthened the state Medicaid system by raising the cigarette tax and directing new revenues toward health care for the poor. But proposed cigarette taxes failed in both the regular legislative session and the recently ended special session.

Clearly the ER is not an efficient place to deliver non-emergency care. The costs of this very expensive care are borne by all taxpayers and everyone who has private health insurance. That's why everyone has a stake in pressing for more options for the uninsured and underinsured.

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