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Comment by mike_d | Hacker News Reader

Only emergency rooms are legally obligated to treat you to the point of stabilization.

As most doctors are now part of hospital ran conglomerates, a failure to pay your bill for an orthopedic consult can still be recorded in the hospitals system and you could be denied an appointment by your OBGYN.

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That's true from an EMTALA standpoint. But in certain circumstances once a doctor-patient relationship has been established and a course of treatment has started the doctor may be legally and/or ethically bound to either continue that treatment or pass the patient over to another willing doctor. They aren't necessarily always allowed to immediately drop a patient for failure to pay.

Keyword: “abandonment.”

The obvious consequence would be that people go to the emergency room for any kind of healthcare. That’s a much worse outcome for hospitals so I doubt they would deny people primary care.

Have you been to an "emergency" room lately?

Nope, and almost everyone reading this hasn’t either. This is not a helpful or productive comment. Instead consider saying “at my last visit to the ER, I encountered many people seeking treatment for XYZ which I do not think should be considered an emergency” or something similar so others can learn from your experience that they don’t have.

It's interesting that we just assume it makes sense for the patient to self assess what level of care they need.

I wonder if there are sensible reasons to not have a single point of contact for unscheduled care, or if it is just dumb inertia?

I know there are some hospitals that have provided urgent care type services at urgent care type prices in their emergency rooms, I haven't looked to see if it worked well or if they are still doing it.

Spelling out what I implied - my experience has been the exact opposite of how OP is insisting that it should be. I'm not interested in typing up a report of my various experiences with the medical industry and scrubbing it of the right amount of identifying information merely to refute some prognostication that's so abstract it's not even wrong.

Yes and I have a company that sells to health systems.

Emergency rooms are already the treatment of last resort for the uninsured. Visit any ER on a Tuesday afternoon in a major city and you'll be stuck in a two hour queue behind what are 95% primary care issues.

The $400 Tylenol people love to complain about in the hospital is a direct result of the government mandate to treat thousands of patients a day effectively for free because we can't get our shit together and provide universal healthcare.

It’s terrible for a hospital’s business to have their ER clogged by people who don’t have emergencies and can’t pay. It means they see a much lower volume of people who can pay.

So they aren’t going to deny people primary care because doing so will just cause them to wind up in the ER.

> It’s terrible for a hospital’s business to have their ER clogged by people who don’t have emergencies and can’t pay.

It is already a big enough problem they don't seem to care. Hospitals in less affluent areas are getting interest free loans from the state to keep emergency care from bankrupting them: https://calmatters.org/health/2023/08/california-hospitals-b...

> So they aren’t going to deny people primary care because doing so will just cause them to wind up in the ER.

You seem to be confused that I am speaking to some hypothetical future situation. Hospital networks require you to either pay outstanding balances or meet with someone to arrange a payment plan before you can be seen. Taking away the ability to report to credit is only going to make them more aggressive in this practice.

I have a company that sells to hospitals, they absolutely care about keeping the wrong people out of the emergency room.

“ Hospital networks require you to either pay outstanding balances or meet with someone to arrange a payment plan before you can be seen.”

Putting them on a payment plan is not the same thing as forcing them to pay. I believe they would force payment for elective care, not preventative.

Hospitals and doctors don’t do this. It’s unethical to deny someone treatment because you’re not sure they can pay.

Emergency rooms don’t do this. Non-emergency health providers of all sorts will deny you services if you have an outstanding balance.

I assume you live outside the United States. Healthcare here is... special.

It may be unethical, but it happens all the time. My father got cancer in 2020 and died earlier this year. During that time, I was continuously shocked at the delays in tests and treatments that he experienced because specialists wouldn't see him until he had approval from Medicare. Without those delays, I think there's a good chance that we'd be looking forward to another Christmas with him.

(We live in the US if this anecdote didn't make it obvious).

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