Centerfield

One of the problems is the growing ranks of the uninsured, including those who aren't covered by Medicare and Medicaid. They have no primary care doctor, so when they have health issues, they're treated in emergency rooms, even for less than urgent problems. This drives up the cost for everyone, and makes insurance even harder to get if you're already uninsured.

Fortunately, a coalition of liberal and conservative issue groups is forming to provide some kind of solution. You can check it out here, in the "Times";

http://www.nytimes.com/2005/05/29/national/29insure.html?ei=5094&en=4ee7fc0aa141bf73&hp=&ex=1117339200&partner=homepage&pagewanted=all

Posted by: Blue Jean at May 30, 2005 05:48 PM

Recently, I've noticed a huge banner on a local hospital claiming that they've taken some steps to reduce ER wait times. ISTR to recall that banner implies something about that reducing costs as well.

Posted by: Jon Kay at May 30, 2005 09:36 PM

Lack of insurance is just part of the problem. It's a whole socio-economic problem. For one, a lot of lower-wage workers have a hard time getting off work to see a doctor during the day. For another, there are segments of the society who see ERs as their defacto healthcare system. Because our healthcare system is so broken, these people often have little knowledge (or care) that going to the ER is incredibly expensive for the system. Also a combination of lack of insurance and lack of education leads many to seriously delay treatment for illnesses that could have been taken care of at a regular doctor's office but are allowed to advance to the point of being an emergency. This lack of education also leads some to misunderstand the seriousness of their ailment.

And that's just the basics. My wife is a physician who works at one of DC's busier hospitals--medical professionals understand a lot of the causes of the ER problems, but solving them is not very easy. The only significant step we could take from a public policy standpoint is to get everyone some form of insurance. But that is easier than it sounds, isn't it?

Posted by: alan at May 31, 2005 12:09 AM

I wonder whether there's some way to skim off those acute URIs into a lower cost treatment regime. Maybe monitor these to figure out when such visits peak, and offer a "sniffles express" that runs from say 12-2 and from 6-8, where people can do an online pre-screening and then get checked out quickly.

Maybe more could be done with education to get people to understand and self-diagnose, and also more could be done to familiarize people with the practice of calling a doctor, doing a phone consult with, say, a nurse practitioner, and avoiding a visit if possible.

Posted by: bk at May 31, 2005 08:46 AM

On February 1, 2004, the day of the Pats-Panthers Super Bowl, I was lucky enough to be passing a kidney stone. It took me a couple of hours to finally give in and go to the hospital. Once there, I spent three hours writhing in pain in the waiting room while the people who got there before me with the cut fingers and headaches were taken in for treatment. When they finally did take me back, after my wife pleaded with them to do so, I was put on a bed in the hallway of the emergency ward because there was no other place for me. At least I got some dilaudid (a really strong morphine derivative)to ride out the next four hours in the hall. If I ever pass another kidney stone, I will call an ambulance just to bypass the system.

Posted by: WHQ at May 31, 2005 09:09 AM

Ouch! Sounds like your ER never heard of triage.

Posted by: Blue Jean at May 31, 2005 10:04 AM

I'll say it loud and proud just as I do now when I proclaim myself to be of and worthy of liberty, i.e., liberal.

In this case, the it is socialized medicine.

Posted by: Tom Chadwell at May 31, 2005 10:44 AM

I wonder whether there's some way to skim off those acute URIs into a lower cost treatment regime. Maybe monitor these to figure out when such visits peak, and offer a "sniffles express" that runs from say 12-2 and from 6-8, where people can do an online pre-screening and then get checked out quickly

BK; A lot of ER's do that via a "fast track" system. It seems to help a little.

Blue Jean;

Sounds like your ER never heard of triage.

WHQ's experience is not uncommon. He probably WAS triaged. As painful as that was it probably took lower priority to the "chest pains" and other that went to the front of the line.

Posted by: c3 at May 31, 2005 11:28 AM

Don't overlook the lawsuit factor in this either. If a person recieves a minor injury at a business, work, event or some other place outside thier home often times they'll be pressured to seek emergency treatment even if they know thier injury is not serious.

For example, I have a freind who recieved a bee sting while at an amusment part. He went to the aid station to see if there was anything they could put on it to reduce the irritation. My freind told the aid station workers that he KNOWS he is not allergic to bee stings. They still insisted on calling emergency services and tried to pressure him to goto the hospital. It took him 45 minutes of arguing and several release forms to convince them that all he wanted was an ice pack and some aspirin.

It's called CYA. The Aid Station wasn't really worried about my freinds health...they were worried about lawsuits. If they get him to go see an ER doctor....then it's the ER who is liable if anything weird happens. Even though they knew very well that he didn't need that kind of atention.

Posted by: cengel at May 31, 2005 11:38 AM

Cengel makes a good point about @ss-covering festivals. I think it makes sense to continue to let Americans have broad access to legal recourse when they are aggrieved. But I think we should acknowledge that we have a problem with liability when it's too generously construed. This sort of thing extends across so many domains. For example, we have a meat thermometer at home that will set off an alarm when the meat reaches a specified temperature (a GREAT tool, BTW). The pre-set specified temperatures are all too high, you can't set it for "beef, rare" unless you want beef, medium well. The numbers aren't close, they go well beyond the issue of meat continuing to cook while standing. I'm confident that it's the legal department that has impacted the design so that someone would buy it and think, oh, it doesn't work.

In healthcare, over-generous assignment of liability to deep-pocketed defendants has elevated "better to be safe than sorry" ER visits to an absurd level. Of course, there are other reasons for it as well.

I don't really like any of the proposed fixes so far.

Posted by: bk at May 31, 2005 12:23 PM

c3,

I can't say for sure whether I was or was not triaged, but the other people in the waiting room looked pretty complacent as they watched television before being called for examination/treatment ahead of poor little me. The apparent order in which people were called was the order in which they came in, with the exception of those arriving by ambulance who received immediate attention. The irony is that I believe I had already endured the most painful part of passing the kidney stone before being given pain medication. The pain was beginning to subside when I was taken in for treatment, so the dilaudid was more of a reward for having endured the pain than a treatment for the pain. If only they had played some Hendrix for me, it would have been worth the wait.

Posted by: WHQ at May 31, 2005 12:44 PM

Perhaps you didn't get Hendrix, but at least you're not like that poor soul who was about to undergo surgery; just as he was falling asleep from the anesthesia, he heard the hospital radio play "Knocking On Heaven's Door". ;-)

Posted by: Blue Jean at May 31, 2005 01:27 PM

WHQ;
Sounds your ER triaged by the critical/not critical method. Probably the best thing about finally getting in was the ability to lay down.

Posted by: c3 at May 31, 2005 04:20 PM