A Weblog of Centrist Voices in American Politics
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A Weblog of Centrist Voices in American Politics | |
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November 19, 2005More than just a TV seriesTime to take a vacation from the Beltway and present one of my periodic medical posts. This courtesy of the Center for Studying Health System Change. Our Emergency Rooms are in trouble. Here are some key excerpts from the report on Rising Pressure: Hospital Emergency Departments. The strains on our ER's due to increased visits, decreased reimbursement and non traditional ER visits are mounting. A few excerpts: ED visit rates continue to grow steadily. During the past decade, the number of ED visits nationally rose 26 percent—from 90 million to 114 million in 2003 —much faster than the 11 percent growth in the U.S. population during the same period. And, while the largest proportion of ED visits are made by the privately insured, since 2001, the privately insured ED visit rate decreased 5 percent, while ED visits by Medicaid patients increased 23 percentUnfortunately more and more docs don't want to help with the increased demand. A national survey of emergency department directors confirms that ED patients are facing access problems for emergency specialty care—two-thirds of the directors reported inadequate on-call specialist coverage. The top three consequences of inadequate on-call coverage were risk or harm to patients needing specialist care, delay in patient care, and increased ambulance diversions from EDs without adequate specialist on-call coverage.And there "not just for emergencies anymore" Emergency departments, with their 24-hour, seven-day-a-week stand-ready capacity, are costly sites to provide primary and nonurgent care. These facilities are not designed or staffed to provide continuous and comprehensive primary care efficiently...Overall, the percentage of ED visits for nonurgent or semi-urgent reasons has increased over the past decade. Nationally representative data show a recent increase in rates of nonurgent and semi-urgent ED visits per 100 persons for insured and uninsured groups, and especially for Medicaid enrolleesProblems like this could drive you crazy. A shortage of inpatient psychiatric beds results in seriously mentally ill patients being “boarded” in ED beds until a space can be found for them elsewhere or until they are discharged. Additional pressures include inadequate numbers of psychiatric practitioners in many EDs and the perception that seriously mentally ill patients present a danger to other patients and to staff in general hospital EDsAnd maybe these are just symptoms of bigger problems out there. The rising pressure in emergency departments is a result of larger forces throughout the health care system, including financial incentives that reward specialist physicians for performing more procedures in physician-owned ambulatory settings and in specialty hospitals; diminishing access to primary care; declining funding for community-based mental health services; and financial pressures on hospitals to pursue business strategies of seeking higher-paying patients and services. Does this make you sick? If so, please stay away from the emergency room! Posted by c3 at November 19, 2005 01:25 AMComments
My healthcare pays 100% of my ER visit. Whether it is a true emergency or not. I feel guilty when I do go to the ER if it's not a true emergency, because I am aware it is a misuse of valuable resources, and I try not to abuse it, but a first care clinic visit pays only 80% and that's after I have met my deductible. If I need immediate medical care I'm off to the ER. All this is DESPITE ER visits taking 4-6hrs, and lots of paperwork to fill in. See, my healthcare charges a $75 deductible for ER visits. And while I'm not thrilled with footing more of the bill in an emergency than for a routine visit, I appreciate that it keeps such visits down. Makes sense to me. The stresses on the system that Chris notes make a pretty obvious suggestion: that it's the uninsured driving this extra burden, and that other parts of the system are doing their best to back away, leaving the parts of the system that can't back away even more stressed. My employer-subsidized premium for next year just went up about 12.5%. Obviously most companies can't keep absorbing such rising costs, and even absorbing part of the cost to keep employees from getting too grumpy about healthcare means keeping wages and salary flatter. No free lunch. Again. Damn. If you ask me, it makes less sense every day to organize healthcare purchasing groups around employment. Since hospitals for the most part can't or won't turn sick people away (largely because we as a culture don't think that should happen), we should mandate some form of coverage for all, and provide a variety of coverage levels, similar to the way in which auto insurance has compulsory and optional coverage. If you truly can't afford it, we all pay for it. We already do anyway, it's just that the costs are spread haphazardly. We'd all care more about it if we could look at our paycheck and see "I paid 2 cents out of every dollar earned for people who can't afford healthcare." Unfortunately, it's unlikely any meaningful reform will take place until the middle and upper middle classes really feel the pain of the problem. The really troublesome thing to me is that its likely that any such future reforms may be geared towards easing that pain, and not decreasing the inequities. Here's the thing: the idea behind insurance is that if you suffer bad luck, insurance protects you from being totally screwed. But too often, serious medical problems cause one to slip through the cracks. Because such serious problems are rare enough, the giant majority of basically healthy people is able to remain blissfully unaware, or willfully ignorant, whichever you prefer to call it. We have to ask ourselves, does it really make sense for insurance to provide full or nearly full coverage for things which many people could afford to bear a portion of the cost (a check-up, a teeth cleaning, a blood test, a flu shot) when doing so means that protection from potentially catastrophic illness is a haphazard patchwork? Posted by: bk at November 19, 2005 10:50 AMI like the personal experiences, they really "fleshes in" the details of this issue. Dennis, be prepared in the future for your insurance to get more from you than a sense of guilt regarding ER utilization. The era of high deductibles, a key aspect of the new "consumerism" in health care, is fast upon us. Brian; Since hospitals for the most part can't or won't turn sick people away (largely because we as a culture don't think that should happen)I agree with the "culture" part. I didn't mention (but the article does) EMTALA, the Emergency Medical Treatment and Active Labor Act. This law was created to prevent "dumping", the transfer of patients from one ER to another because of inability to pay. In short, the law requires every ER to see any patient regardless of ability to pay. So unlike a doctor's office, you can't be turned away because of payment issues. This encourages the use of ER's as de facto primary care offices. Posted by: c3 at November 19, 2005 01:24 PM |
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