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January 8, 1992

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

Author Affiliations

Harbor-UCLA Medical Center Torrance, Calif
UCLA School of Medicine Los Angeles, Calif

JAMA. 1992;267(2):232-233. doi:10.1001/jama.1992.03480020041018

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