More uninsured patients are being seen in EDs than ever before, but this isn't the main reason for overcrowded EDs, according to a new report. Crowding occurs for many reasons, including increased use by everyone, fewer EDs, and fewer inpatient beds.

To explore common but "unsupported" assumptions about ED use by the uninsured, researchers conducted a retrospective literature search from 1950 through September 19, 2008. Basing their findings on 127 articles meeting study criteria, they concluded that "available data do not support assumptions that uninsured patients are a primary cause of ED overcrowding, present with less acute conditions than insured patients, or seek ED care primarily for convenience." The data did support the assumption that ED care is more expensive than office-based care when appropriate, but this is true for all patients.

"People without insurance tend to use the emergency department less than any other group, and when they present they tend to be sicker," explained lead study author Manya F. Newton, MD. "We have a crisis in the emergency department and we have a crisis with the uninsured, but it is crucial that we do not assume that the latter is causing the former."

Sources: Newton MF, Keirns CC, Cunningham R, Hayward RA, Stanley R. Uninsured adults presenting to US emergency departments: assumptions vs. data. JAMA. 2008;300(16):1914-1924; Brown AJ. Uninsured not main reason for ER crowding. Reuters Health Information. http://www.nlm.nih.gov/medlineplus/news/fullstory_70667.html.