As numbers of the uninsured go up, so do ER visits

[WhiteTara]

Source: SF Gate

(08-06) 18:45 PDT -- Hospital emergency departments, typically the medical providers of last resort, are becoming the only option for insured as well as uninsured people who are unable to get care elsewhere, leading to a record rise in emergency room visits over the past decade, a federal government report found.

ER visits jumped more than 32 percent from 90.3 million in 1996 to 119 million in 2006, the most recent year statistics are available, according to the National Center for Health Statistics, a division of the Centers for Disease Control and Prevention.

"The uninsured have long been more frequent users of (emergency rooms). That's not new. What's new is the rise ... in frequency in visits, and that's occurring in the insured," said Dr. Stephen Pitts, author of the report and a CDC fellow, who teaches emergency medicine at Emory University's School of Medicine.

Pitts said the difficulty in getting primary-care appointments could be contributing to the rise in ER use, particularly by those with insurance or on government programs such as Medicare or Medicaid.

"The likely cause is there are just fewer and fewer primary-care physicians," he said. "If you were to get the flu and your doctor says, 'Sure, I'll see you in two weeks,' you may not be able to wait. It's hard for even insured people to get quick appointments and be seen quickly."

Read more: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/08/06/MN8N1268D3.DTL

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the collaspe of this country is almost complete

[DJ13]

1. My long time family doctor told my wife and I two years ago he couldnt treat us

.....because we had always paid him in cash.

No insurance, no Medicare, no healthcare.

[babylonsister]

2. OMG, it's not only immigrants 'ruining' Emergency Rooms?

People are hurting, I don't care what their background is. And it's getting worse.

[Kali]

3. Now that is some breaking news!

:eyes:

[countmyvote4real]

4. I can't get an appointment with a doctor unless I'm referred by the ER.

Of course, a doctor within the hospital can refer me to another doctor, but I can't get to any of them unless I go to the ER first.

[elias7]

9. how many ER visits does it take to get a primary care referral: 1

One visit. Your statement makes no sense in explaining repeated ER visits

[Mira]

5. Kick and hoping for more recommendations Quote Bush July o7:

“The immediate goal is to make sure there are more people on private insurance plans. I mean, people have access to health care in America. After all, you just go to an emergency room.”

[Lorien]

6. And that's one of their biggest arguments against universal health care

"but you have to WAIT for an appointment"! Hell, I've always had to wait weeks-sometimes months-to see my GP. And I have ended up in the ER too because I couldn't get in to see any other doctor before the situation became dire. The system is completely shattered.

[cascadiance]

8. Shit I waited ALL NIGHT to see a doctor for 15 minutes in the morning in ER...

Just a few months ago, I had a kidney stone, and I know that's something you don't want to "wait" until it passes, especially if you're alone in the house. I could sense it coming on right before midnight, and only had the one emergency center open here locally (all of the others close around 8 PM at night).

I got there at midnight and probably saw more janitors coming through the waiting room to sweep and clean the toilets than health professionals. They were definitely understaffed. I had a test or two in the first hour of waiting, and spend a good 15 minutes to a half hour just talking about my insurance with someone behind a bullet proof window.

I watched 100 best comedies marathon review on the TV there all the way through (a few hours). Was wondering if I had a sequel script going... Heck, around 4 AM in the morning, they actually came in to PAINT the waiting room, and kicked us all into the emergency room offices at that point, which were packed to the max.

I think I waited a lot longer than others partly because as I was there longer and longer, it was probably more likely without any severe pain happening, that I'd passed my stone already and didn't even need to be there. I therefore kept getting knocked down the waiting list of a relatively busy and understaffed waiting room.

Finally got to see a doctor around 6:00 AM (I think she was the only one on staff), who noted that test results probably indicated I had one and that it had passed, and she gave me a pain killer prescription...

Now to top that off, even with insurance, I got billed almost $350 for that piece of non-service, and those billing me billed me in two separate bills. And the local clinic i go to in the same medical group didn't have access to EITHER of those billing systems when I tried to go in and pay them.

The whole thing was a carnival of errors. Great treatment for our pay to play system? MY ASS!!! (or perhaps in this instance another part of my anatomy)

[elias7]

10. carnival of errors?

I don't see any. You say you got billed for non-service, yet, you were seen by the physician and did have tests amd did receive prescription. Had you been in more severe pain, you would have gotten IM/IV pain meds in the ER.

Most ER's, excepting the larger hospitals in urban centers have only one physician on staff. The fact that you had to wait from midnight to 6AM supports the OP: that ER was busy all night, staff probably run ragged.

I don't imagine they paint the waiting room every day. It's nice the that it was painted at all, and that there was a TV you could watch.

[cascadiance]

12. I said they were understaffed, and THAT was what in my book is "nonservice"

I don't think those working in Canada (if in fact there are waits there as well) are intentionally not serving people, if in fact there are delays. I think most health professionals do so are working there professionally.

If supposedly the money we are paying is supposed to pay for a higher quality service and more timely service, then this situation utterly was a failure.

I don't blame the staff there ar all. They were courteous and effective when I met them. I do blame the system though that understaffed them, especially on a night they should have PLANNED for interference from painting activities they should have known about in advance. If they had been well staffed then, then likely most patients, including me would have all been cleared out by the time they wanted to pain the place. Poor management that keeps trying to minimize costs and maximize profits, and WE pay the bills for it.

I also blame the billing systems for not being centralized and I have to spend extra time and effort to pay the increasing number of bills, and my health insurance for increasingly making me pay more of the bill for such situations, even when I'm staying in network.

And as the OP points out, more people depending on ER visits for health care affects people like me, who have insurance that pays the bill (and me INCREASTINLY with higher deductibles and percentages). The system is broken, and that the myth that we get more for our "money" being paid into the system than countries with Univ. Health Care is exactly that.

[Seldona]

7. While it isn't perfect, the Wisconsin model should be looked at closer.

I lost my NON-HMO insurance the year Bush was selected, and have been on BadgerCare ever since. They would have taken me off, since I became ill and cannot work, but my doctor simply wrote them a note and the insurance continued. I believe all we pay is a 1.00 co-payment on meds, but that is set by income.

There are still a lot of uninsured single people here, but that is changing as well as the BadgerCare system is going live to everyone at some point in the future, with affordable healthcare for ALL Wisconsinites. I believe it will SAVE money in the long run, because people will have true access to the best PREVENTATIVE care, with primary care physicians acting as gatekeepers.

Repukes are working hard as hell here to wreck it, but we are still a pretty damn progressive place to live if you stay out of the Milwaukee area, which is rife with red. Hell it is the rural counties that gave Kerry this state, it was so close.

This scares the shit out of me though. What happens if the repukes happen to beg, borrow, or steal, their way to power here? I would be well and truly fucked.

I'm with Malloy, have I mentioned how much I hate these people?

[melm00se]

11. this brings up a second and, IMO, more serious issue:

When universal/single payer health insurance comes to be, how is the existing medical infrastructure, which appears to be straining at the seams now, going to cope with an increase of 40 million + "paying" customers?

Doctors, nurses, medical equipment, physical space are not going to appear overnight; they take time to educate, train, license, certify and build.

[cascadiance]

13. Well many of those that we spend our 30% overhead will go work in other insurance industries...

... who's current job in the system is to study and build rules on how to avoid covering certain people and situations. With Universal Health Care, those individuals and costs wouldn't be needed any more, and the money could be instead used to hire staff that really are a part of the system of providing health to people, not just people trying to find ways to not provide care in the name of profit.

[melm00se]

14. I am not sure that will solve the problem.

there will still be people evaluating claims and the "need" for specific care and procedures or there will be a large increases of things like this:
http://ap.google.com/article/ALeqM5jaD627V_u_hm4koV2o-2DYuICCDgD92B3OH00
and will all of the people who do as you indicate want to switch back to the actual patient care aspect of medicine? they went to do backoffice work at insurance companies for a reason.

While universal healthcare will certainly address quite a few issues, it will lay bare quite a few new issues some of which are obvious but some we won't see until they are exposed.

[cascadiance]

15. I'm sure that it will be like other "universal care" systems in other countries..

... where their overhead is far less than 30% it is now for our commercial health care, and even our medicare is far less thant his is now with our insurance based care.

There will always need to be people involved to ensure the system is running properly and not being scammed. Though yes, those people aren't necessarily "health care" expertise people and more people with finance backgrounds, they aren't the same people that look through to find creative ways of dismissing whole categories of coverage for people, when that no longer is an option when everyone is entitled to care. This latter group of people is the group that comprises a big chunk of that 30% overhead costs that will likely need to find newer jobs. Some may try to do the other financial tasks (if they are available), and others may switch to something like the auto insurance industry or the like where perhaps there isn't mandatory coverage in those segments and their expertise can be used.

With that reduce set of costs, you can put that money back into increasing numbers of staff that actually can help handle the increased influx of patients, and perhaps hire more people focused on preventative health care than emergency care, if people aren't waiting for "emergency situations" any more to try to go in to get health care.

Other countries are able to do this and have lower overhead than we do. Why can't we? Now perhaps we have more people in our society trained in the skills here that we'd be trying to get rid of (those focuse on who to eliminate from coverage). Well, our society in the past has sdjusted to increased/reduced demand in different market segments (and I would argue in more destructive ways with current outsourcing crap that's going on). I think many kids going to college would look forward to seeing more demand for actual health care professionals than being paper pushers, and that gap wouldn't take that that long to correct.

[melm00se]

16. What I'd be interested in seeing

is whether or not there was a shortfall in the number healthcare providers with other countries and then extrapolate it out to a country with 300+ million people spread out over an area the size of all of Europe.

If there is a short fall and while there will be $$$ available, it will still take: 6+ years for a doctor (that's just the medical school piece and for a "basic" doc much less a surgeon or a specialist), 2-8 years for nurses (depending upon level of certification), 4+ years for a physician's assistant etc so if there aren't enough folks now, it will take that long for the system to bounce back. Plus there will have to be an adjustment in the costs associated in nursing/medical schools as there will be a dramatic drop off, in most cases, in medical incomes.

My point is I haven't seen where the staffing numbers/needs have been taken into account just a focus on the 40+ million that don't have insurance.