The ER is full

3 Mar
2005

I have to link to this article. The author is a medical school classmate (MCV ‘75). Unfortunately, I will miss my 30th medical school reunion because they made a mistake and scheduled it for the 1st night of Passover. Hugh has written a nice summary of why too many patients come to the ER. Readers of this blog know the solution.

Pileup in the Emergency Room

How did it come to this? Easy. Imagine any system with shrinking supply and increasing demand for something important. Then imagine one source of relief in this system, one place where you can get what you need regardless of your ability to pay, where they have to and want to help you, and do so very well. Unless that one resource has infinite capacity, it will be overwhelmed.

I understand how health care planners with limited vision might have decided years ago that unoccupied hospital beds meant inefficiency. But demand fluctuates around an ever-rising curve. I understand that legal restrictions on hospitals’ ability to “dump” indigent patients were needed, but we now have screening rules interpreted to require immediate and extensive evaluations of anyone at an emergency department who might have anything serious. I understand that consumer advocates and plaintiffs’ lawyers are concerned about tort reform that might make it harder to sue, but the nearly random nature of that system leads some providers to feel that they have to do everything for everybody.

First eliminate the health care planners and let the market sort it out.

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5 Responses to The ER is full

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DJB

March 4th, 2005 at 11:36 am

CO-PAY! At my hospital a $10 walk through the doors fee would cut our pt. load in half. no more “I have a hang nail so I came to the ER”. Force people to prioritize. As of now the only cost-benifit consideration is time spent in the waiting room. Like you said, let the market work it out.

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Carsten

March 4th, 2005 at 10:10 pm

Good idea, but doesn’t work… Insurance co-pays for ER visits are $35-$50 in my area, but people still come in for very silly reasons. Maybe because it is post-billed, and half of them have no intention of paying the bill anyways.

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jb

March 5th, 2005 at 3:53 pm

If your ER is really overloaded with trivia so that real emergencies are not seen efficiently, send every patient through the required screening exam, then triage the non-emergencies to the “pay your deductible before you are further evaluated desk.” Once it is determined that there is no urgent problem, EMTALA no longer applies, and it becomes an ordinary office visit.

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DB’s Medical Rants » The future of medicine

March 7th, 2005 at 9:39 am

[...] are careers. Our lack of sufficient high quality primary care leads to excess ER visits – The ER is full. Medicine really does take more time in 2005 than it took in 1975 (my int [...]

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free meds

March 8th, 2005 at 11:57 am

An alternative are the urgi-care’s but for whatever reason people feel the best service and care is provided by the big white building on the hill…

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