Researchers have found that many uninsured patients are deterred by long wait times and choose to seek emergency care at hospitals where they are billed rather than access free care at Chicago's major public hospital, the John H. Stroger, Jr. Hospital of Cook County.

After surveying 157 patients at three hospitals -- one for-profit, one not-for-profit and one public institution -- near the county hospital, the researchers analyzed demographic data, information on insurance, income, health status and debt.

The majority of patients who had received care at the county hospital in the previous five years were satisfied with the quality of care they received, but 75 percent were unsatisfied with emergency department wait time, and more than 60 percent said they were not likely to return to the safety-net hospital.

"We found that wait times had become so severe at County that many patients simply would not return there, even if they were very concerned about their credit problems and the costs of care they would incur at the site where we interviewed them," said Dr. Saul Weiner, associate professor of medicine and pediatrics at the University of Illinois at Chicago and lead author of the study. "We concluded that wait times alone could make safety-net care unacceptable, even to those who need it most."

The researchers found that nearly three-quarters of the patients surveyed had household incomes less than $20,000, almost half said they were in fair or poor health, and one-third were already in debt at the hospital where they were seeking care.

Safety-net hospitals across the country are overburdened, and this study shows that access to care may be about more than location and cost, Weiner said. In order for safety net providers to be accessible, wait times must be reduced.

A previous national study of emergency department overcrowding in academic medical centers found that some patients waited up to 40 hours to receive care.

The study, published online March 24, appears in the Journal of Urban Health. Co-authors include Jonathan VanGeest of Kennesaw State University, Richard Abrams of Rush University Medical Center, Arthur Moswin of Michael Reese Hospital, and Richard Warnecke of the UIC School of Public Health.

The study was supported in part by The Robert Wood Johnson Foundation, the nation's largest philanthropy devoted exclusively to health and healthcare.

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