NEW YORK – According to a recent PricewaterhouseCoopers survey, more than half of Americans surveyed believe that if universal health coverage is passed by Congress, it will not ensure equal access to care because of capacity constraints, particularly in emergency rooms.

The PwC  survey of 1,000 American healthcare consumers reveals fears that universal coverage could swamp the health system unless steps are taken to create innovative care delivery models that will expand access to care without adding cost to the system. 

The PwC survey found that a significant number of consumers would be open to the idea of shared doctor appointments, online physician consultations, worksite clinics and other alternative ways of receiving medical care.

"It's clear that access to insurance coverage does not translate into access to care," said David Chin, MD, a PwC principal and leader of the PwC Health Research Institute, responsible for the research. "The quick fix is to build bigger emergency rooms, but increasing supply will only drive up healthcare costs. We must find solutions that expand access without adding costs, and we believe the answer lies in new flexible models to care that use the right technologies and incentives and behavior changes to unclog jammed access points."

Americans in general – not just the uninsured – are using costly hospital emergency rooms more frequently as the first point of entry into the health system, according to PwC. Per capita visits to hospital emergency departments already are at an all-time high, reflected in overcrowded emergency rooms, diverted ambulances and long waits. 

The reasons for the overcrowding are varied and include a shortage of physicians, lack of access to specialists, Medicaid reimbursement disincentives, high costs for the underinsured, poor coordination among practitioners, growing consumer demand and inefficiencies throughout the system, according to PwC.

The PwC report also found:

• Patients covered by Medicaid use emergency rooms at twice the rate of the uninsured, even though the uninsured are most often blamed. Forty-four percent of Medicaid respondents visited an emergency department in the past year, compared to 20 percent of uninsured respondents.
• More than half of all people who visited an emergency department in the past year said they went for a reason other than an emergency – for example, their doctor's office was closed or they couldn't get an appointment in an acceptable time.
• Emergency rooms have become holding tanks for mental health patients because of a shortage of mental health providers and beds. The average length of stay in the emergency department for patients in need of mental health services is double that of other patients.
• One in four consumers and one-third of all Medicaid patients said it takes more than 30 days to see a doctor. One in 10 said they've had to wait three months or longer.

PwC found an inverse relationship between insurance status and emergency department use. States with high uninsured populations generally have lower emergency room use than states with lower uninsured populations. For example, Massachusetts, which has one of the lowest rates of uninsured residents (3 percent), has one of the highest per-capita use rates of hospital emergency rooms in the country.  

In addition, Massachusetts has the highest number of physicians per capita but has been plagued by a severe physician shortage since introducing near-universal coverage in 2006, PwC researchers said.