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the hospitals inefficiencies but also larger problems in access to primary and specialty care. The Institute of Medicine published a three-report series on the state of the U.S. emergency... and the resources of each, the number of inpatient beds in the local health care market, community access to primary and specialty care (including mental health services), insurance... coverage rates, the communitys overall health status and the hospitals obligations under the Emergency Medical Treatment and Active Labor Act (EMTALA) [2]. ED efficiency is affected...