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Patients Leaving Emergency Departments Without Being Seen by a Physician

Frederick J. Hass, MD
JAMA. 1992;267(2):231. doi:10.1001/jama.1992.03480020041014.
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To the Editor.  —In Dr Kellermann's editorial1 regarding the crisis of emergency department overcrowding there are some salient points he fails to address specifically enough to shed more light on the situation.He correctly notes a "substantial proportion" of the 90 million emergency department visits made each year are "made for episodic ambulatory care." This is an inappropriate use of an emergency department. Get these patients appropriate ambulatory care and the crowding problem will be solved. Baker et al2 point out in their article that of the patients surveyed, 78.3% had no insurance, 12.5% were enrolled in Medi-Cal, and 5.9% were enrolled in Medicare. This amounts to a whopping 96.7%. Only 2% had private insurance. One must conclude that people with private insurance can get care elsewhere.In the good old days, primary care physicians cared for a great many of the 96.7% of patients in their offices and very


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