Nearly half of US medical visits are at emergency rooms
sciencedaily.com
sciencedaily.com
It's not half of US medical visits to any kind of medical care that are at emergency rooms. It is half of US medical visits to hospitals that are at emergency rooms.
That's a big difference. Among other things, they are not including visits to your family physician. If they included ordinary visits to your doctor outside of the hospital, then emergency rooms visits would be a much lower percentage.
Looking at the original abstract:
http://journals.sagepub.com/doi/10.1177/0020731417734498
It says, "Our study aimed to determine the contribution of EDs to the health care received by Americans between 1996 and 2010 and to compare it with the contribution of outpatient and inpatient services using National Ambulatory Medical Care Survey and National Hospital Discharge Survey databases."
They are comparing emergency visits to other kinds of hospital visits.
Perhaps we ought to reverse the incentive.
Well ... yeah.
Even beyond the family physician, there are many specialists that are affiliated with hospitals but see patients in their offices, outside of the hospital registration process.
In fact, those specialists often have offices in the hospital or in buildings attached to the hospital.
Although anecdotal, multiple family members who are health care providers in the ER (Nurse, PA, Doctor) it's more often than not far from an emergency ailment. This creates a scary supply and demand scenario.
1 - Any time a condition/illness causes bad nausea/vomiting, the urgent care will send you to an ER to get IV meds and fluids, which they can't do. You probably don't need a full ER, but that's the only place to go. This must be fairly common during flu season, and a huge waste of resources. A startup idea could be an Uber for off-hour home visits. If all you need is IV fluids, check some vitals, keep you comfortable to ride-out a nasty virus, surely it's in everyone's interest to have a quick visit by a nurse/PA, possibly MD.
2 - Pain management. If you have a relatively new illness or injury that requires stronger medications to manage the pain, you have no choice but to go to an ER, or perhaps be admitted to a hospital (which is even more expensive). I can't say if over a longer period of time, for a chronic case, there are better options that eventually get worked out. But 2 months into such an issue with a family member, and going to the ER was frustratingly the only option.
3 - Chest pain. Yes, it could be a heart attack, so maybe an ER is the best place to go. You will get triage pretty quickly with an EKG, and some basic vitals, but you're still stuck there for hours if it's a false alarm (I'm guessing quite often). There's got to be a better way.
For that reason, I visited ER twice that week, and was diagnosed with some mild stomach issue and stress. Every single test they ran gave negative result. It's a huge waste of time for me, and I feel very guilty for wasting ER resources (especially as an immigrant). There has got to be a better way.
Edit: I was very lucky to be covered under school-mandated health insurance, and I don't think you could live comfortably in the U.S. without having one.
That's the missing equation - that for the uninsured, the only remaining medical option is the ER.
Comparatively, Emergency care/Ambulances are available almost everywhere through 911 AND take most of the mind space around urgent issues.
Finally, Urgent Care centers are not equipped to handle lots of things like broken bones etc. They just refer you to an emergency center instead.
Maybe we should just put the Urgent Care facility in the same building as the ER and then route people appropriately when they show up.
My girlfriend went to an Urgent Care with a stomach bug. They asked if she had any abdominal pain, and she said yes. That was a flag for them to say "We can't handle you because abdominal pain is a flag for possible appendicitus so you have to go to the Emergency Room now."
There was no way she had appendicitus. She just needed an antibiotic. But you follow the hospital's advice, and stepped into the ER and suddenly was charged $5,000 for useless tests and had to stay there for 6 hours.
thanks?
> It was widely believed that having insurance would encourage people to get routine medical care in doctors' offices or clinics, instead of waiting until they have more serious symptoms and have to head to the ER, where care is most expensive.
> The study's first findings, published a few years ago, showed that Medicaid was beneficial in many ways. It improved people's financial security. They went to the doctor when they were sick. And having the insurance correlated with a drop in rates of depression.
> But the study also found Medicaid enrollees increased their emergency room visits by 40 percent over the first 15 months.
[0] http://www.npr.org/sections/health-shots/2016/10/19/49852611...
edit: fixed medicare / medicaid
That's the whole question.
It's possible that people without insurance would have just never gone to the doctor and then died without ever being treated by anyone. Dying of some preventable condition is obviously worse for them, but it doesn't inherently result in more money being spent on healthcare.
Sure, letting people suffer and die is cheaper on the medical systems books - but people dying earlier than they need to is a negative cost on our society and larger economys side ... let alone the ethical questions there.
Not so much, because of the way emergency rooms work. What costs is the capacity, not what you use it for. You have to pay the going rate for a surgeon who can do open heart surgery, even if that doctor is only administering aspirin for a headache.
That's why a $.25 band-aid costs $100 at an ER.
> Sure, letting people suffer and die is cheaper on the medical systems books - but people dying earlier than they need to is a negative cost on our society and larger economys side ... let alone the ethical questions there.
But the original problem was that people can't afford healthcare, either individually out of pocket or collectively as insurance premiums or taxes. If covering more people under government insurance doesn't reduce costs then it doesn't solve the problem -- people still won't be able to afford healthcare.
It doesn't help anything to make it mandatory as taxes so that they end up not being able to afford rent or food instead of health insurance. We need to figure out how to actually reduce costs so that the amount of healthcare people need costs less than the amount of money they have, so that it's possible for people to get healthcare without going bankrupt.
That probably means people paying for more things out of pocket, because out of pocket payments shouldn't have triple the expense due to insurance paperwork, and people only compare prices when it's their own money.
There is a wealth of data that shows that the problem with health costs is in fact solved by strong government involvement in health care in systems where people don't pay out of pocket at all ... ignoring that data is willful ignorance.
http://www.pbs.org/newshour/rundown/health-costs-how-the-us-...
Proposing alternatives government involvement are interesting, but not very constructive if we can't even get to the point of agreement of how well real world health systems perform in other nations vs the US.
Just comparing costs doesn't work when there are so many asymmetries.
The US has far lower density than those countries, which increases costs because it makes it necessary to have a lot more idle capacity in order to maintain a reasonable emergency response time.
And a big part of the cost that the US system pays and nationalized systems don't is actually legitimate -- it pays for medical R&D. If we just regulated prices like other countries then that money disappears -- which is fairer, but that doesn't mean it wouldn't cost lives. Other countries have lower costs because they're ripping us off by not paying an equal share. Unless you can convince them to pay more, we can't eliminate that cost without eliminating the research it pays for.
Moreover, there is no question that parts of the US system are terrible -- especially the insurance companies and the amount of overhead and inefficiency that comes from using "insurance" to pay for non-catastrophic care. But it should be possible (politics and corruption notwithstanding) to change that part of the system without nationalizing the whole thing.
Because national healthcare has its own problems. From your link:
> In Japan, if spending in a specific area seems to be growing faster than projected, they lower fees for that area.
That's the bureaucratic solution. It absolutely works to keep prices down. As long as you don't mind that it implies responding to demand by spreading the existing resources thinner without regard to how that affects outcomes.
There is a reason the US has a worse average but a better median. There have to be ways to reduce costs and help the bottom 20% without hurting the middle -- and that's the only thing that will pass anyway, because you can't get 50% of the votes with something that will reduce the quality of care for the other 80% of people.
The density argument doesn't make sense. If that were true, New Jersey would have cheap healthcare on par with "those countries" that have similar population densities. New Jersey would also have cheap, super-fast broadband and a robust statewide public transportation system, other things that people claim the U.S. simply can't do because population density.
For example, one of the strongest indicators of high healthcare costs is having a Democratic majority in the local legislature, which tends to correlate with density and cancel out the benefit. If you look at the red states you can clearly see the effect of density -- the higher density southern red states (Texas/Georgia/Virginia/Carolinas) have lower healthcare costs than the lower density northern red states (Alaska/Wyoming/Nebraska/Dakotas).
Well, did they go there because they were actually ill? If so, the experiment did in fact improve public health.
> "Medicaid coverage increases emergency department use, both overall and for a broad range of types of visits, conditions, and subpopulations," says Amy Finkelstein, an economics professor at MIT and one of the authors of the study.
> "Including visits for conditions that may be most readily treatable in primary care settings."
[0] http://www.npr.org/sections/health-shots/2014/01/02/25912808...
That's just engrained practice. People used to go to the ER instead of a regular physician, now they continue what they always did. You ask yourself why the hospital doesn't set up a regular practice on the premises and has triage send patients there.
More seriously, I suspect routing routine patients to lower-cost settings would put ERs more in the red under our current system.
In Texas, they are legally prohibited from doing so. They would have to send you to a physically-separate location, even if said location was still in the hospital's parent network.
It seems like it doesn't take any more resources to take care of me next week then it does 6 weeks later.
Instead, the 6 weeks is a result of 1) the number of people who wish to get appointments, 2) the time that each person spends, and 3) the number of people who can be treated at a time:
MeanResponseTime = MeanNumberInSystem / MeanThroughput
[0] https://en.wikipedia.org/wiki/Little%27s_law#Finding_respons...
If people call for an appointment, and find they have openings this afternoon and tomorrow morning, they'll be more likely to go to the doctor. If they find that the earliest appointments are 12 weeks out (as I did when trying to schedule a physical before a recent trip to Asia - ended up skipping the appointment), they're going to go elsewhere.
If you're viewing the queue as a sort of plumbing system, this can be approximated as backpressure.
"The high-income group, with average household income greater than $70,000, is the standard to which all others are compared... 30 percent of the population in the $30,001–$50,000 range ...have 59 percent more mortality than is true of the richest group."
[0]: http://content.healthaffairs.org/content/21/2/31/F2.expansio...
Source: http://content.healthaffairs.org/content/21/2/31.full
We could at least have a little compromise by making health care more tiered so that citizens, payers and people with insurance receive better health care than others. Make a list of services that will only be provided to payers and automatically push non-payers to the back of the queue.
Additionally, we already had that system in place, it was called "lifetime limits" and it was typically $1-2m on the best healthcare plans.
Ie: I broke my toe and I have insurance, so I get ER treatment, but that guy who has no insurance and is internally bleeding to death from a street stabbing (and is hispanic, doesn't have insurance and maybe isn't american?) is pushed behind me in line. That is the real life scenario that at least one person is advocating here.
I think as the governments become more starved (not made more efficient by reducing costs, starved by simply cutting funding without optimizing it logically) that important government services will have to replaced with tiered private companies. As regulations are removed, the same thing occurs.
What if a speed of ambulance was built into your insurance? How do you know what response time is right for you and your family (as it will be framed)?
It's impossible for that not to be the case. It's even the case in countries with single payer, because rich people who live there and don't want to wait for an appointment or want something that isn't covered will just go to a country that can give them what they want and open their wallet. Even without leaving the country, they can hire private nurses and so on when they aren't covered by the national health system.
Moreover, why is this supposed to be a problem? "Money buys things" is the purpose of money.
There are things a rational national health system wouldn't pay for because they aren't economical, but a rich person would buy for themselves for much the same reasons they buy a Tesla instead of a Dodge. Which means they have a safer car because they have more money. Should we prohibit expensive safer cars because poor people can't afford them?
Shouldn't triage take into account who is the most profitable so wealthy people can go to the front of the line where they deserve to be?
I mean really, why should my undocumented nanny, house keeper and gardeners be entitled to the same health care that I am? [Of course, I don't pay them enough to buy health insurance but that's their problem.]
As @gselevator tweeted "I never give money to homeless people. I can't reward failure in good conscience."
(This is sarcasm in case it isn't obvious.)
It totally reads like the kind of libertarian/dude-bro nonsense that has invaded tech.
I'd be wary of reusing text like this in other areas, because until I skipped ahead to "this is sarcasm" I was like "oh here we go again"
The next question would be: how many of the people that ended up on the ER could actually afford healthcare? And why didnt they have/use it?
https://data.oecd.org/healthres/health-spending.htm implies that the US is spending considerably more (~ double the OECD average) per capita. ER visits could certainly explain some of that.
The crux is making it easier for consumers to get health care information, putting more choices in the hands of the patient, and creating a mechanism to encourage price sensitivity even if people don't pay for their care directly.
We're mired in this current system with no rationing, low accountability, and rentiers sucking cash with the Government's approval and leftist protection against any reduction to the cashflow. Look at the yelps ushered by leftists when Trump stopped giving insurers free money - many of them bemoaned the loss of corporate welfare.
The crux is making it easier for consumers to get health care information, putting more choices in the hands of the patient, and creating a mechanism to encourage price sensitivity even if people don't pay for their care directly.
failing that, let them rely on charity.
It's within the first two pages, look for the paragraph that starts with this
5. Said charges under (3) and (4) will, when submitted to Treasury