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An increasing number of patients have turned to emergency rooms at Montgomery County hospitals for treatment in recent years, but officials say it is too early to tell whether the current economic crisis and unemployment are intensifying the trend.
"At this point we have not quantified that that is happening," said William G. Robertson, president and chief executive officer of Adventist HealthCare, noting that evidence is scarce partly because the increased job and health insurance losses are relatively recent.
Visits to the emergency rooms at Washington Adventist Hospital and at Shady Grove Adventist and its satellite emergency center in Germantown increased 4.7 percent and 13.4 percent, respectively, from 2006 to 2007.
A mix of factors has contributed to the increase, Robertson said, including an aging and changing population, as well as adjustments in insurance coverage.
Also, fewer people have a primary care physician, said Dr. James Del Vecchio, medical director of the emergency department at Holy Cross Hospital in Silver Spring.
More physicians are going into more lucrative specialties, where less time is spent having to navigate government regulations and insurer requirements. And primary care physicians who are still practicing are tightly scheduled, leaving patients to wait days or weeks for appointments, Del Vecchio said.
"Probably of equal importance lately, with both parents working, we're seeing an increase in people using the emergency department after hours because they cannot get to a physician [during] regular hours," said Rebecca K. Vasse, director of emergency services at Shady Grove Adventist Hospital and its Germantown emergency center.
Although statistics on the percentage of uninsured patients were not available from Holy Cross, more uninsured people have been coming to the hospital's emergency department over the past two years, Del Vecchio said.
To help handle the less-critical care needs of uninsured adults, Holy Cross also operates a primary care center on the Takoma Park campus of Montgomery College and is building primary care centers in Gaithersburg and Wheaton.
Insured or not, the number of patients coming to Holy Cross Hospital's emergency room spiked two years ago, when the increase in ER admissions jumped from 6 percent to more than 10 percent.
ER visits to Holy Cross went up 13 percent in the budget year that ended in June.
But locally, and nationally, statistics do not prove that lack of insurance is the reason.
The percentage of uninsured patients increased from 12 percent to 13 percent at Shady Grove Adventist Hospital over the last year and from 16 percent to 17 percent at Washington Adventist Hospital, said Marisa Lavine,a spokeswoman for Adventist HealthCare.
Officials at Suburban Hospital in Bethesda and Montgomery General Hospital in Olney say they have not seen a significant increase in the number of patients or the number of uninsured patients coming through their ER doors.
A study published in the Journal of the American Medical Association last month found that "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."
