KAI RYSSDAL: You might know somebody this has happened to. They break an arm or something. Then spend hours waiting in a jam-packed emergency room. Urgent care facilities in the US are chronically overcrowded. Conventional wisdom has been that it's the uninsured and the undocumented who are causing the delays. But, Helen Palmer reports from the Marketplace Health Desk at WGBH, what might seem obvious can be wrong. And much of it depends on where you live.
HELEN PALMER: Boston, Massachusetts, and Cleveland, Ohio, have few Hispanic immigrants and low numbers of uninsured. Yet people there visit the emergency room almost twice as often as residents of Orange County, California, or Phoenix, Arizona, where many lack insurance and there are many Hispanic immigrants. That's demonstrated by analysis of the actual numbers of ER visits in different parts of the country in 2003.
PETER CUNNINGHAM: Uninsured people and Hispanic immigrants are not heavy users of emergency rooms.
Peter Cunningham of the Center for the Study of Health System Change wrote the report. He says the cost of the ER deters the uninsured and undocumented. And there's another deterent, says Lourdes Galvan of the Hispanic rights group Consejo de Latinos Unidos.
LOURDES GALVAN: The undocumented people that are here in the states do not like going to ER's because they don't like to divulge the personal information. They're afraid.
Galvan says Hispanics often prefer traditional alternative remedies to American medicine. But even if undocumented aliens aren't flooding the ER's, they're still a problem, says hospital finance expert Jim Unland.
JIM UNLAND: The problem with undocumented aliens is that they put hospitals in an untenable position financially regardless of the amount of utilization.
Unland publishes the Journal of Healthcare Finance. He says most illegal immigrants can't pay, but by law hospitals have to treat them.
UNLAND: Our healthcare system treats them. The problem is they don't qualify even for Medicaid.
The border states suffer most financially, says Unland. A report from the U.S. Mexico Border Counties Coalition reckoned hospitals and emergency service providers lost more than $200 million caring for undocumented aliens in 2000.
In Boston, I'm Helen Palmer for Marketplace.