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Who's Using the ER?

When you don't have health insurance, the cost of a trip to the doctor's office can be pretty daunting. So where do you go for medical care? The emergency room.

By law, hospitals in the United States must treat patients regardless of their ability to pay. That makes ER's the de facto safety net in a health care system that otherwise has never offered universal coverage.

And with a tanked economy, at least a third of the state's hospitals say they've seen an increase in ER visits by uninsured patients, according to the California Hospital Association. Such a trend can make it difficult for hospitals to stay afloat financially (see our segment about Downey Regional Medical Center).

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Who's Using The ER

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But the uninsured aren't the only drain on hospital resources. The poor and the elderly get steep discounts on their treatment through government-run programs such as Medi-Cal and Medicare. Hospitals provide the services, but only get compensated about 20 cents on the dollar, according to financial data published by California's Office of Statewide Health Planning and Development.

The OSHPD numbers depict a hospital system overwhelmingly dependent upon a minority of customers who carry private insurance. Statewide, hospitals faced payment shortfalls of $2.2 billion from uninsured patients in 2008. They lost $5.7 billion more to patients on Medi-Cal and Medicare the same year, according to the office's financial reports.

Collectively, the only group of patients to net positive revenues for the state's hospitals were those with private insurance—that is, those who purchased individual coverage or elected to join a group policy through their employers.

The privately insured brought in a little more than $8 billion in 2008. But subtract the $7.9 billion in shortfalls hospitals had to swallow for the poor, the uninsured and the elderly, and you're left with just shy of $400 million. That's the amount hospitals made from treating patients in 2008, collectively. That's the operating income shared among all major hospitals in the state.

The picture is even more bleak if you look at the CHA's numbers, which show a shortfall of nearly $10 billion that has to be made up by payments from the privately insured.

All these numbers represent overall operating costs and income, but they do give a sense of the impact each group of payers can have on emergency rooms, too. After all, that's where many of the uninsured go to seek their medical care.

So who's really using the ER in California, and how are they paying? Take a look at the accompanying charts and see for yourself.

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