4 ms·

If I recall, EMTALA is the law that states that hospitals must provide emergency medical care to someone regardless of their ability to pay. Do we really want

If I recall, EMTALA is the law that states that hospitals must provide emergency medical care to someone regardless of their ability to pay. Do we really want to live in a society where people are refused treatment for medical care just because they can't pay at that time?

patrickg_zill 10y ago
The problem with EMTALA, is that it is routinely abused to get non emergency care. As a result, some hospitals have found that it is better to close ERs; which of course means less emergency care when it is actually needed.
- maxerickson 10y ago
  Here's the question though: Why don't ERs have a billing code that is essentially a walk in visit that costs a sane amount? My vague understanding is that the answer is along the lines of "they don't understand economics" and have worked over time to push lower risk care out of the ER, instead of working to handle it at lower cost inside of the ER, making the typical ER visit more and more expensive to handle... The architect of the ACA literally said the same thing about hospitals, moving services out of the hospital where possible to save money. But that just means that either the utilization of the hospital goes down (driving up costs) or the complexity of the care delivered goes up (driving up costs).
  - riahi 10y ago
    Because paying people to be there 24/7 is not as cheap as paying people to be in an urgent care from 9-5 or even 9-9. Precisely because the facility is designed to handle massive emergencies means that your fixed costs are inherently higher. Just because you intend to use a supercomputer to browse HN doesn't mean the price to buy the supercomputer gets cheaper. If that's your intended use-case, you should buy a cheaper tablet / go to a cheaper level of care. EMTALA's greatest problem is its unfunded mandate where people are required to provide 24/7 emergency care without regard for ability to pay. Since it's effectively "free", people abuse it and show up at all hours for non-emergent issues because they don't want to wait.
    - maxerickson 10y ago
      It depends on the utilization rates though. And the facilities could be designed to handle smaller issues too. The local hospital here runs an ER and an urgent care center about 60 feet away; from a practical standpoint I'm 100% certain that the urgent care could be the same intake as the ER. I'm less certain about it, but I believe the reason it is not is because there are structural incentives in the various reimbursements they get. Those incentives probably do make sense in places where ERs are over used. Here, most of the time, they create redundancy.
- tboyd47 10y ago
  Is that so? I have never seen a hospital in my life without an ER. Most hospitals in my area loudly advertise their ER even from the interstate.
- Cthulhu_ 10y ago
  That's a symptom of another problem though - lack of accessible and affordable health care outside of the ER or clinic. What a country needs is a tiered healthcare system, like we have in NL; non-emergency things (the sniffles, complaints, etc) -> GP appointment or walk-in hour. Minor emergency (e.g. pneumonia, etc) -> on-call, night shift GPs (they rotate). Major emergency -> go to ER if possible, else, call ambulance. Point being, people going to the ER when they don't need to is a symptom of other problems.

patrickg_zill 10y ago

The problem with EMTALA, is that it is routinely abused to get non emergency care. As a result, some hospitals have found that it is better to close ERs; which of course means less emergency care when it is actually needed.

maxerickson 10y ago
Here's the question though: Why don't ERs have a billing code that is essentially a walk in visit that costs a sane amount? My vague understanding is that the answer is along the lines of "they don't understand economics" and have worked over time to push lower risk care out of the ER, instead of working to handle it at lower cost inside of the ER, making the typical ER visit more and more expensive to handle... The architect of the ACA literally said the same thing about hospitals, moving services out of the hospital where possible to save money. But that just means that either the utilization of the hospital goes down (driving up costs) or the complexity of the care delivered goes up (driving up costs).
- riahi 10y ago
  Because paying people to be there 24/7 is not as cheap as paying people to be in an urgent care from 9-5 or even 9-9. Precisely because the facility is designed to handle massive emergencies means that your fixed costs are inherently higher. Just because you intend to use a supercomputer to browse HN doesn't mean the price to buy the supercomputer gets cheaper. If that's your intended use-case, you should buy a cheaper tablet / go to a cheaper level of care. EMTALA's greatest problem is its unfunded mandate where people are required to provide 24/7 emergency care without regard for ability to pay. Since it's effectively "free", people abuse it and show up at all hours for non-emergent issues because they don't want to wait.
  - maxerickson 10y ago
    It depends on the utilization rates though. And the facilities could be designed to handle smaller issues too. The local hospital here runs an ER and an urgent care center about 60 feet away; from a practical standpoint I'm 100% certain that the urgent care could be the same intake as the ER. I'm less certain about it, but I believe the reason it is not is because there are structural incentives in the various reimbursements they get. Those incentives probably do make sense in places where ERs are over used. Here, most of the time, they create redundancy.
tboyd47 10y ago
Is that so? I have never seen a hospital in my life without an ER. Most hospitals in my area loudly advertise their ER even from the interstate.
Cthulhu_ 10y ago
That's a symptom of another problem though - lack of accessible and affordable health care outside of the ER or clinic. What a country needs is a tiered healthcare system, like we have in NL; non-emergency things (the sniffles, complaints, etc) -> GP appointment or walk-in hour. Minor emergency (e.g. pneumonia, etc) -> on-call, night shift GPs (they rotate). Major emergency -> go to ER if possible, else, call ambulance. Point being, people going to the ER when they don't need to is a symptom of other problems.