Local emergency rooms are seeing a big spike in patients without health insurance, increasing waiting times and costs for everyone, according to a Bee analysis of state and national health data.
Among those patients is Shannon Zeitler, who lost her medical insurance when she lost her marriage. She recently went to UC Davis Medical Center for help controlling her seizures. There was no urgency for her visit, she conceded, but she had little choice.
"I was so under stress. I knew I needed to get some medicine in me," she said "I had no doctor. ... I'm $7,000 in the hole now."
Emergency room visits by uninsured patients like Zeitler have surged more than 25 percent across the capital region since the recession began, The Bee found, based on its review of forms hospitals file with the Office of Statewide Health Planning and Development.
During the first six months of 2008, about 35,000 ER patients in the four-county region told their hospital they would try to pay the bills themselves. During the same time frame this year, that number rose to 44,000.
Total ER visits -- by the insured and uninsured -- also have risen, but not as sharply.
The increase locally is "reflective of what's happening statewide," said Jan Emerson, spokeswoman for the California Hospital Association.
In a survey released this spring, the association found that 57 percent of hospitals statewide registered an increase in the number of uninsured patients seeking care in their emergency rooms.
Economic problems blamed
Local hospitals cite two economy-related factors: job loss and government budget cuts.
"On a daily basis, the status of the economy is probably on the forefront of our minds," said Dr. John Wiesenfarth, emergency services chief for Kaiser's Sacramento Medical Center.
The closure of government clinics leads more to use the ER as a substitute for a family physician, Wiesenfarth said. In the past year, Kaiser has reported a 30 percent increase in local ER patients and a 40 percent increase in patients paying out of pocket.
"Working on the front line, we see more and more people using it for their primary care or their only source of care," Wiesenfarth said.
Nobody benefits from these trends, said Rosemary Younts, director of community benefits for the Sacramento region of Catholic Healthcare West.
The uninsured can get stuck with a larger bill, causing them stress and damaging their credit. And everyone has to wait longer to see a doctor.
"Of course, if a person comes in, we treat them," Younts said, adding that hospital officials try to get patients with milder problems to use Mercy's lower-cost primary care clinics.
The extra traffic "extends the waiting time for all patients," Younts said. "It crowds the ERs and puts pressure on medical staffs."
Group gives state an 'F'
The American College of Emergency Physicians recently cited overcrowding as a factor in awarding California an "F" for access to emergency care. It blamed much of the crowding on a lack of emergency facilities in its "National Report Card on the State of Emergency Medicine," but said "contributing to the problems are high rates of uninsured adults and children."
Hospitals end up absorbing many of the unpaid bills. Last year, hospitals across California wrote off nearly $1.2 billion in bad debts. And they wrote off $973.4 million in free care -- an 89 percent increase from four years earlier.
"In the big picture, it's raising the cost of health care," Younts said of the rise in ER use by the uninsured.
Cost shifting because of the uninsured is expected to add about $1,100 this year to insurance premiums for the typical American family, according to the Center for American Progress Action Fund, headed by John Podesta, former chief of staff for then-President Bill Clinton. In California, that shift now adds $1,400 to insurance premiums.
While many patients come in with minor issues, ERs also see more patients with conditions that should have been treated sooner, Younts said -- like Lisa Martinez of North Sacramento, who put off treatment as long as possible.
Martinez has rheumatoid arthritis, but has had no insurance since she lost her restaurant job last year. She can't afford the $2,000 shots she needs to control her pain, so instead she's taking 16 ibuprofen tablets a day.
"That has a powerful effect on the kidneys, and I should be under watch by a physician," she said, holding up palms that look as though they have a heavy weight attached to them. "If you saw me this morning, you'd say, 'Lisa, you need to go to the emergency room.' "
More rely on Medi-Cal
Emergency rooms also are seeing more patients enrolled in Medi-Cal and other government insurance plans -- a shaky proposition amid deep budget cuts. Eric Young and Crystal Masten, for instance, are Medi-Cal patients who visited the Methodist Hospital emergency room early Thursday when Masten burned her arm.
"I've got a full-time job but I don't have benefits," Young said, adding that together he and Masten take care of their four children, and that Masten has chronic kidney problems.
They worry that their insurance might get axed. The government, Young observed, "has been cutting programs left and right, so cuts do seem inevitable."
Methodist is a Catholic Healthcare West Hospital, one of five in the region, including Mercy San Juan and Mercy General. Comparing the first six months of 2008 with the same period this year, those hospitals have logged increases in self-pay patients ranging from 7 percent to 45 percent.
Especially troubling, CHW officials said, are recent jumps in uninsured mental health patients. Sacramento County has deeply cut funding to its mental health facility within the past year.
"They have no other place to go," Younts said, and, she added, most of the region's ERs aren't equipped to offer mental health patients much more than safety and a room.
Overall patient load up
Some local hospitals downplayed the increases. Sutter General reported its self-pay emergency room visits rose by 25 percent the first six months of this year compared with the same period last year, while Sutter Memorial saw an increase of 37 percent, according to OSHPD data.
Sutter hospital officials explained the rise in self-pay patients as part of the overall increase in patients. ER visits at the two hospitals increased about 10 percent during the first six months of the year, according to the state data.
Still, "we're trying to be mindful of that increase," said Michael Taylor, director of patient services for Sutter Health's Sacramento-Sierra region.
Sutter has added 11 people to its team of patient advocates, who help the uninsured and low-income patients navigate government programs and point them toward agencies that offer financial assistance.
From April to June, about 800 patients at Sutter's two Sacramento hospitals received help applying for government assistance. In addition, the hospitals approved charity assistance to nearly 2,100 patients, according to the health system.
At UC Davis Medical Center, officials reported a far smaller number of patients paying out of pocket than any other hospital, but a larger number of patients covered by Sacramento County's indigent care program, which works like Medi-Cal. Those differences in reporting made it hard to get an apples-to-apples sense of insurance trends at UC Davis.
Still, the number of self-pay ER visits reported by UC Davis increased about 15 percent during the past year.
Shannon Zeitler remembers her trip to the UC Davis Medical Center clearly. When she awoke to find herself convulsing in her bed early on Aug. 28, she realized she needed medication -- fast.
She knew she had epilepsy, but it had been a dozen years since her last seizure and she had been off medication for quite a while.
The ER seemed her best bet to get help immediately, but now -- facing $7,000 in bills, some of which she is contesting -- she regrets that decision.
"I should have just waited until I could see my old doctor," Zeitler said. "I wasn't prepared for the charges at all."
Call The Bee's Phillip Reese, (916) 321-1137. To see more of The Sacramento Bee, or to subscribe to the newspaper, go to http://www.sacbee.com/. Copyright (c) 2009, The Sacramento Bee, Calif. Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.
Copyright (C) 2009, The Sacramento Bee, Calif.