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Letters
November 10, 2010

Trends in US Emergency Department Visits

JAMA. 2010;304(18):2014-2015. doi:10.1001/jama.2010.1579

To the Editor: The study by Dr Tang and colleagues1 addressed the potential effects of increasing numbers of uninsured persons on US emergency departments (EDs). Spain has a different health care system model, set up as an integrated National Health Service that is publicly financed and that provides universal health care free of charge at the point of use. Provision is mostly publicly owned and managed; this applies to all general practitioners and primary health care centers, to outpatient specialized clinics and physicians, and to 80% of hospital care. Governance of the system is decentralized, with local organization in each of the 17 autonomous communities (or regions) that comprise the Spanish state. There is no cost-sharing for public primary, outpatient, or inpatient care in Spain, and the entire population (including legal and illegal immigrants) has free access to the health system.2

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