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Nearly half of US medical visits are at emergency rooms
- trendia 9y agoStrangely, a study on whether providing expanded medicaid* would reduce emergency room visits seemed to suggest that it did not: > 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/2016/10/19/498526110/emergency-room-use-stays-high-in-oregon-medicaid-study http://www.npr.org/sections/health-shots/2016/10/19/49852611... edit: fixed medicare / medicaid
- ameister14 9y agoMedicaid =/= Medicare; totally different population
- trendia 9y agofixed
- dv_dt 9y agoIt's odd that the rates of going to the ER are discussed, but not the content or cost of the care during the visits... particularly when the article discusses the speculation that the increased visits might be doctors referring patients to the ER to take care of some specific condition... and you would think that would be lower cost than catastrophic care later.
- AnthonyMouse 9y ago> and you would think that would be lower cost than catastrophic care later. 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.
- dv_dt 9y agoAnd if you look at rates of visits, while ignoring cost/content of the visits it seems like you're missing a big part of the analysis. 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.
- AnthonyMouse 9y ago> And if you look at rates of visits, while ignoring cost/content of the visits it seems like you're missing a big part of the analysis. 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.
- HarryHirsch 9y agoBut the study also found Medicaid enrollees increased their emergency room visits by 40 percent over the first 15 months. Well, did they go there because they were actually ill? If so, the experiment did in fact improve public health.
- trendia 9y agoFrom another article on the same study (albeit earlier): > "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/2014/01/02/259128081/medicaid-expansion-boosted-emergency-room-visits-in-oregon http://www.npr.org/sections/health-shots/2014/01/02/25912808...
- HarryHirsch 9y ago"Including visits for conditions that may be most readily treatable in primary care settings." 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.
- dv_dt 9y agoIs the ER a cost center or a profit center? Often times, I wonder if even the hospitals themselves know... More seriously, I suspect routing routine patients to lower-cost settings would put ERs more in the red under our current system.
- vonmoltke 9y ago> You ask yourself why the hospital doesn't set up a regular practice on the premises and has triage send patients there. 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.
- mikestew 9y agoWell, what does one expect when the answer given by many when the topic of socialized medicine comes is "go to the emergency room, they can't turn you away for having no money"?
- fav_collector 9y agoEspecially when it covers non-citizens and people who are illegally in the country. 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.
- nck4222 9y agoI would view that as a horrible compromise, because it would result in poor people receiving worse health care than wealthy people.
- throwaway5752 9y agoI'm amazed sometimes the things people say here. The idea of withholding medical care based on citizenship comes very close the criteria for evil, with the drawback that it's largely incorrect, too (non-citizen residents, legal and illegal pay taxes at many levels of government for far less in return comparably than citizens).
- ythn 9y agoWhat is the maximum amount we should spend to save a human? A million? A billion? Should society absorb any cost to save a human even if it gets exponentially more expensive with each subsequent procedure? Or should there be a cutoff where you are basically told "Sorry, you've exceeded the threshold and have to either pay for it yourself or die"
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- PaulHoule 9y agoWhat I can't get is that my primary care doc makes me wait 6 weeks to get a checkup. It seems like it doesn't take any more resources to take care of me next week then it does 6 weeks later.
- trendia 9y agoThe reason you have to wait 6 weeks is that the doctor's office does not have infinite capacity, and increasing that capacity would require adding nurses, doctors, and rooms. 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_response_time https://en.wikipedia.org/wiki/Little%27s_law#Finding_respons...
- nradov 9y agoThat doesn't really work for medical offices. A better solution is to reserve more schedule slots each day for patients who call or just show up that day. That makes the overall system more efficient since patients with urgent symptoms don't have to go to urgent care or ER.
- trendia 9y agoUrgent Care clinics might help fill the gap between long term care (where delays are OK) and emergencies (where delays are not OK).
- nradov 9y agoUrgent care is still more expensive than visiting your regular doctor. And it's less effective because the urgent care doctors are less familiar with you as a patient, so it takes longer to get up to speed on current symptoms and the risk of error is higher.
- LeifCarrotson 9y ago
- Mrtierne 9y agoJust another report highlighting the need for change to our current healthcare system. 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.
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- angmarsbane 9y agoI think one benefit of the emergency room is that you know it'll be open. Doctor offices follow normal working hours. Every time I've ended up in an emergency room its for something that happened in abnormal hours.
- nradov 9y agoThe usual solution is urgent care clinics with extended hours, although in some areas they aren't open 24 hours. Symptoms always seem to get worse at 3 AM.
- ribosometronome 9y agoSome? I'd guess that in most areas, they aren't open 24 hours. As far as I know, SF (for example) doesn't have any urgent care centers that are open overnight.
- irrational 9y agoSame here. Our local urgent care places aren't open very late, so every time we've gone to the emergency room is because it's the only medical establishment open.
- gricardo99 9y agoYup. The system is pretty messed-up and from my view (as a user), it drives people towards ERs as there are few other options. Some examples: 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.
- exhilaration 9y agoUrgent Care facilities and walk-in clinics can fill the need for immediate, after-hours care at a far lower cost than the ER. Here's a screenshot from my health insurance provider, you can see it gives options along with a comparison of their cost: https://imgur.com/a/4Lqb7 https://imgur.com/a/4Lqb7
- mrguyorama 9y agoI'd disagree that showing a few dollar symbols a real cost comparison
- chiph 9y agoMake sure that it really is an Urgent Care - there are starting to pop-up businesses which are (or at least promote themselves as) Emergency Room alternatives. They charge like an ER too, so you could end up with a large bill.
- exhilaration 9y agoGood point, but I think that depends on whether your state allows them. I've seen standalone emergency rooms in Texas but not in Pennsylvania and New Jersey. One of my relatives in Houston is an ER doc and works at one of these standalone ER's, when I asked him why these exist (in contrast to urgent facilities) he told me it was purely because they can charge significantly higher ER rates.
- okreallywtf 9y agoMost urgent care facilities around me are only open till 8 or 9 - good enough for things that happened while you were at work but couldn't get to your GP for but the world doesn't stop after that. The few times I've been to urgent care they are so understaffed that if there are 3 people in line at 6:30 you'll be lucky to get seen by closing time.
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- ryanobjc 9y ago
- trhway 9y agojust a personal anecdote (i don't think that such situation affects any significant percentage of people though) - English words "urgent" and "emergency" translates to basically the same Russian word which means "emergency". Given that "urgent care" is missing in Russian medical system (at least 20 years back it was), we, being recent arrivals and thus not very skilled in both, English language and the details of US medical system, were going to "emergency" whenever told to go to "urgent care", and we were so disappointed that regular US doctors would refuse to see us except by appointment of some weeks/month in the future when an issue would require prompt attention, and they would be sending us to "emergency" instead (as it sounded to us when in reality it was urgent care). We thought that it is such an inefficient system - either appointment in 2 months or emergency room (where we'd wait 3-4 hours - obviously our issues weren't any close to priority there, and where we obviously wouldn't get a specialist attention which would better suit the issue we came with). Sometime later (after 6 years in US :) we did accidentally learn about urgent care.
- alexanderstears 9y agoStop letting the elderly and poor use E.R rooms as convenient one stop shops and it'll sort itself out.
- knz 9y agoDo you have an alternative proposal for how these people access health care services? https://data.oecd.org/healthres/health-spending.htm 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.
- alexanderstears 9y agohttps://market-ticker.org/akcs-www?post=231949 https://market-ticker.org/akcs-www?post=231949 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.
- knz 9y agoRespectfully, I feel this link is missing the broader picture - that the US has a health care system unlike any other OECD nation. Perhaps the crux is looking at models that have been successful in other countries and adapting them to the US?
- alexanderstears 9y agoAmerica should lead the world in healthcare and many of those proposals would help us accomplish as much. 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.
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- rdtsc 9y agoEven with insurance, they implicitly encourage people to say everything is an "emergency" because otherwise you'd have to call them to get approval. But if you say "it was an emergency" you can avoid having to jump through hoops. So you go, and it clogs the emergency room, everyone pays more.
- wnevets 9y agoDidn't one of the anti-obamacare republicans say this is how most americans should get their medical care?
- gsnedders 9y agoHow does this compare with elsewhere?
- excalibur 9y agoThis isn't that surprising. The cost of health care is so astronomical that many people WITH insurance refuse to go to a doctor until their condition is so bad they can't avoid it any longer, and then it's straight to the ER.
- jackmott 9y agoyeah having insurance, even for some of us with six figure jobs is "we give you a small tax break on the first 10,000 you spend on health care every year in exchange for paying us $300 a month!" thanks?
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- fishcolorbrick 9y agoHere's a nice graph[0] showing the relationship between income inequality and healthcare, and a good quote: "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.expansion.html http://content.healthaffairs.org/content/21/2/31/F2.expansio... Source: http://content.healthaffairs.org/content/21/2/31.full http://content.healthaffairs.org/content/21/2/31.full
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- mysterypie 9y agoThe summary and headline are badly misleading. It sounds like shocking news, but what they really found is disappointing but not that surprising. 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 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.
- candiodari 9y agoSo what you're saying is, after years of providing a strong financial incentive to get all your care via emergency departments, people are surprised to what extent the population actually takes this incentive ... Perhaps we ought to reverse the incentive. Well ... yeah.
- payne92 9y agoBingo, I’m so glad you clarified this. Something “didn’t smell right“ here. 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.
- 0xbear 9y agoThe disappointing part of the US medical system is it doesn’t do much for you unless you’re really seriously ill or about to die. If you’re about to die, it’s the best in the world. If you just eg have a shoulder pain or something — you will have great difficulty finding a competent doctor to deal with it. People discover this by their mid to late 30s, around the time they begin to have their first real health problems.