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Patients Leaving Emergency Departments Without Being Seen by a Physician-Reply

David W. Baker, MD, MPH; Carl D. Stevens, MD, MPH; Robert H. Brook, MD, ScD
JAMA. 1992;267(2):232-233. doi:10.1001/jama.1992.03480020041018.
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In Reply.  —Dr Hass argues that many physicians have stopped providing charity care because of decreasing reimbursements from public and private insurers. If this has occurred, then reduced payments for insured patients cannot be the whole explanation. Family practitioners, internists, and pediatricians all had an increase in their net incomes from 1982 through 1987, and in 1990, office-based physicians in private practice reported a 6.9% increase. 1 Most of this increase was due to higher fees rather than an increased volume of services. It is doubtful that further increases will augment physicians' willingness to provide charity care. Providing health insurance would appear to be a more reliable way of guaranteeing access to care.It seems unlikely that national health insurance would worsen overcrowding as Dr Kunst suggests. While the hospitals and clinics that care for the uninsured are overcrowded, other providers are underutilized. Expanding health insurance coverage would allow those

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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