Nearly a third of emergency departments closed over the last two decades, while ER patient visits increased 35% during the same period.
Between 1990 and 2009, the number of hospital emergency departments in non-rural areas in the USA declined by 27%, according to a study in Wednesday’s Journal of the American Medical Association.
“That’s a hefty number, and more than I expected,” says study author Renee Hsia, an assistant professor of emergency medicine at the University of California, San Francisco. “The demand for care has increased and has rapidly outpaced our supply. They’re going opposite directions.”
I definitely object to this:
[blockquote] The widely held idea that ERs are sucking the health care system dry is a myth, says Sandra Schneider, president of the American College of Emergency Physicians. “About 92% of patients who come to ERs have to be there. So you’re not going to get the money you need by closing emergency departments.” [/blockquote]
The National Organization of Community Health Centers pegs the figure at 50% of visits to the ER are for non-emergency reasons. This later figures certainly jibes with my experience. Community health centers should be the center of health care reform. Unfortunately, obamacare is fixated on the “underinsured” problem rather than a safety net problem.
Medical costs have exploded in the same period that government health insurance covered numbers have increased dramatically, now at 29%. These are not unrelated!
And Obamacare’s dramatic expansion of the Medicaid rolls will make matters worse, just as it has done in Massachusetts under Romneycare.
Could it be that 50% of ER visits for non-emergency reasons are because it’s the only available health care source for the non-insured? What other source must provide health care without the ability to pay?
“Could it be that 50% of ER visits for non-emergency reasons are because it’s the only available health care source for the non-insured?”
Not only the uninsured but patients with Medicaid and increasingly those with Medicare are being boxed out as well. Thus, they are turning to the ER for primary care visits. My point is that one can simply say, “Everyone has Medicaid, today!” but that won’t solve the problem, rather it will make matters worse. Stop talking about the uninsured. Start talking about the safety net and patching holes in it. The Community Health Centers provide the backbone to the safety net at a much reduced cost to giving the poor Medicaid and having them go to the ERs for primary care. Instead of increasing funding to CHC’s, the Obamacare mandated increased in medicaid is hurting the CHC’s funding.
I am very very slowly, and with great pain, coming to the conclusion that an all private-for profit health care system is unworkable, unless we are prepared to abandon the 1/3 of Americans who have either no insurance or who are dangerously underinsured. We are the only country in the industrialized world that still rations health care on the basis of ability to pay. Generally I bristle when people say ‘you should do it our way or the way it is done in country N.’ That said, I think there comes a point where if you are utterly isolated in the world, then maybe it’s time to ask if maybe there isn’t a better way.
There is a difference between conviction and hubris.
The status quo no longer works. It’s time to stop tinkering with a hopelessly broken system, as we have been for decades, and just bite the bullet. Unless we are prepared to abandon the poor and working poor to private charity I believe some form of universal national health insurance is going to have to be adopted.
And this will get worse. The ER is now the entry way to get just about any care you need. No appointment, don’t have to pay, can go at any hour, especially at night after the good TV programs are over, especially since so many stay up all night anyhow and just sleep in since they don’t need a job. Such a deal, and all specialities available 24/7 with the best of equipment such as CT scans, MRI the works. Add to that the fact that most docs have long ago stopped all the lab and procedures such as minor surgery, treating brokem bones, wounds because the reimbursment is too low or non-existant and the medical liability is atrocious. So off to the ER, preferably in a city or state hospital with sovergian immunity and salried physicians. Such a deal. Add to that the nursing homes that have a physician visit once a month who just send anyone there with a problem on to the ER. I just saw a patint that had a feeding tube that was stopped up and sent to the ER at 11:30 PM to get it changed. In the old days the nurse would just put in a foley catheter and the next day sent to the office where a “button” access could be inserted in ten minutes. Now we don’t dare do that in our office or nursing home. This patient had at the ER a full evaluation, lab, xrays, etc and then a foley inserted and sent back to the nursing home with instructions to get an appointment with the gastroenterologist for a new endoscopy and new placement of tube. Oh by they way, the ambulance charges $350 for the trip each way–four trips that I use to tend to myself in the office. BTW when I quit doing this my liability fell by two thirds- about four times what I got reimbursed each year. Nice. Now add to that, that everyone will have the Obama card that none of us will take so off to the ER for care. What possibly could go wrong. Oh, and no one ever asked us what would work. Doesn’t the government do a great job on all it’s project? This is what the people voted for, Enjoy.
[blockquote]I am very very slowly, and with great pain, coming to the conclusion that an all private-for profit health care system is unworkable,… [/blockquote]
I’m not sure what evidence you have for that conclusion. What system are you saying is unworkable? The system we have in the U.S. right now is far from a “all private-for profit health care system”. Medicare, Medicaid, CHIPS, VA, and required E.R. services. These are a large portion of our health care system, not to mention all the non-profit/charities such as Shriners.
Part of the problem is the Medicare and Medicaid programs pay too little and the cost have to be made up somewhere else.
I think the main problems with our system are:
1) Prices based on what insurance and Medicare and Medicaid will pay, not the cost/benefit of the service.
2) The customer not knowing what the services they get cost before they agree to them.
3) What the customer pays does not have much to do with the value of the service they get.
4) Insurance tied to jobs (this is a hard one to untie).
The biggest problem is
5) Almost everyone thinks they have the right to what ever medical care they want, even if they cannot pay for it.
If you want to stop the rise of medical costs and improve services here is a 5 Step Plan:
1. Outsource/transition government run programs to private insurance pools. Insurance companies can bid on a package for detailed services at a regional or state level.
2. Prohibit health care coverage from being paid by anyone other than the covered individual. Options and lowered costs will emerged when people pay directly for their costs.
3. Allow competition across state lines.
4. Allow physician owned hospitals and Emergency service providers.
5. Allow individual HSAs to be passed on the death of the account holder to a beneficiary tax free and restricted for health coverage.
And I want to add, “Duh?” What did they expect to happen (increase in emergency visits and decrease in emergency clinics)? Remember this from the health care bill so loved by the Democrats and more than a few Republicans?
The whole bill was crafted to stop private expansion of emergency services and force individuals into state managed ER care in Urban areas. It isn’t enough that hospitals help patients, they have to help them equally. The government has to decide what the market needs, instead of demand for services leading the market. Rather than the doctors who live in the community deciding there is a need for more beds, that community has to rely on a government bureaucracy to research the inpatient admissions of all the other hospitals in the county. To the government, the desire for quality of service or need has no bearing on hospital admissions. What matters is that a doctor owned hospital doesn’t have a bed occupancy rate greater than the state average (i.e. take business from the government). So again I ask, why is the State Hospital is the primary choice? Helloooooooo…
Just thank the Democrats and their Republican allies in the fall as you vote. You will vote, won’t you?
Its the “odd” doctor here that actually admits anyone to the hospital. This is usually done through the “emergency room” EVEN if the Doc sends you there.. Our primary care physician, doesn’t do “hospital”. He might suggest it, BUT the decision to admit you is made by a “hospitalist” (one of four rotating folk). I know, since my husband has been there three times since last December..
THe problem is, when you leave, unless its a surgeon that did surgery on you, you must “follow-up” with your various physicans, who in the our case are sent copies of the release orders.
The follow-up appointment can take two weeks to get, so IF something goes wrong, its back to the ER for you. WHAT a mess!
And its getting worse.. He, got MRSA, and pneumonia from his last visit, and has been out a week. Still running around to “follow up” with the 4 Doctors (not the hospitalists) involved.
I’m about done in, this has been going on since Mar 31.. And he is very slow in getting better..
I wonder what people do that don’t know how to handle the “system”.
Grannie Gloria
Grandmother, sorry to hear about your medcal problems. You are correct. Most primary care docs are leaving hospital admissions. Hospitalist are coming in rapidly and will soon be everywhere. First of all, almost none of our medical graduates are goiing into primary care. With hugh debts after graduation, they must go into lucrative specialities such as anesthesia, surgery, radiology, etc. The pay by insurance and govenrnment is very small and in our area Medicare is below your overhead and Medicaid is worse. Also, the field of geriatrics is dead. It is pure socialized medicine and for the most comlex patients requiring the most time it pays at the bottom. Only ten percent of us that had board certification in geriatrics have renewed them. Few go to nursing homes anymore. The pay continues to go down and this January the government announced that they would no longer pay for consults! So we are all out of the hospital. In our area a few years ago primary care all announced that we would no longer take unreferred call after we got lots of suits from street people and no pays. Later all the surgeons quit taking trauma patients. Since there is a subspecialy in trauma, they did not want some schyster asking them in court why they treated the patient who did not turn out perfectly if they were not board certified. So we all are “decertifying” from any complicated aspect of medicine. So the hospital will have to hire salaried physicians and cover their liability. Many hospitals that are goverment owned have sovereigan immunity. Fortunately, most of the hospitalist are very competant, but usually only so so with geriatrics which is a separate speciality. I quit admitting about two years ago because the hospital could not get enough good nurses to keep up the quality I required. Also, we have always made our most in our own offices that we control When doctors feel abused, they don’t usally riot, write letters, picket, or carry signs. They just quietly disappear. Obama Care is the worst threat our nation has faced in years, not because it will destroy medicine, but will wreck our entire nation. There wil not be a recovery as long as it is a threat to business. My business friends are sitting on their money and not hiring or expanding as long as they know they will be swamped with costs and regulations as well as taxes. IMHO