Universal access: its potential impact on emergency medicine

Area of Science:

• Health Policy
• Economics
• Public Health

Background:

• Current economic conditions, including a recession impacting the middle class, may drive the passage of a US universal access plan.
• This plan aims to provide essential medical benefits to uninsured individuals currently seeking care in emergency departments (EDs), doctor's offices, and as inpatients.

Discussion:

• A universal access plan could strengthen physician-patient relationships and facilitate medical care access for the working poor.
• It is hypothesized that such a plan may decrease routine ED visits if accessible, high-quality primary care alternatives are developed.
• The plan is expected to improve the collection rates of billed charges for emergency physicians.

Key Insights:

• Third-party payers' managed care strategies may struggle to manage the pressures of ensuring quality care, expanded benefits, and cost reduction under a universal access system.
• Increased micromanagement by payers to control expenditures could make it harder for emergency physicians to find specialists willing to treat previously uninsured patients.

Outlook:

• The implementation of a universal access plan presents challenges for third-party payers in balancing cost containment with comprehensive patient care.
• Public and teaching hospitals may continue to be primary sites for uncompensated care delivery, a pattern established over decades.