4 ms·

This is actually a common problem with what is, in practice, an already socialized portion of American healthcare: Emergency Rooms Since emergency rooms cannot

by lgbr 14y ago

This is actually a common problem with what is, in practice, an already socialized portion of American healthcare: Emergency Rooms Since emergency rooms cannot turn patients away, there are a lot of people to come to the emergency rooms for things like pains in their big toe, menstrual cramps, and so on. This is why the emergency room is so absurdly expensive in the United States. Health care here really isn't very expensive so long as you go nowhere near the emergency room. Sources: http://www.thenewstribune.com/2011/09/25/1839726/state-decides-whats-not-a-medical.html http://www.thenewstribune.com/2011/09/25/1839726/state-decid... http://www.bizjournals.com/albuquerque/print-edition/2011/09/23/urgency-or-emergency-ads-target-er.html?page=all http://www.bizjournals.com/albuquerque/print-edition/2011/09... http://birminghammedicalnews.com/news.php?viewStory=1275 http://birminghammedicalnews.com/news.php?viewStory=1275

neurotech1 14y ago
Your blaming the patients, without considering the lack of primary care in the US. Some HMO "covered" Primary Care Providers(Physicians) have a 2-3 week wait for an appointment etc. Certain hospitals have "express care" or "urgent care" on premises, that will treat patients without insurance, same as the ER. Santa Clara Valley Medical Center has a pretty efficient "express care" clinic.
dinkumthinkum 14y ago
But your logic here is flawed. People go to the ER for those things, which are normally legitimate problems, because they can't afford to go to a regular physician. It's sort of ironic that you would pick this example. The idea that health care here really isn't expensive outside of ERs ... is just kind of ridiculous. I think it would be a better argument to say "I don't care about them, screw them if they can't pay" than to use this reasoning -- at least it has the potential for being realistic.
FireBeyond 14y ago
Firefighter / paramedic (/ IT geek) here: I took a patient today out of the ER (via ambulance) to a skilled nursing facility. There were a lot (for us, 6+) ambulances in the receiving bay. Patient comments: "Wow, busy. Usually when I'm going to the ER, and I see that many ambulances, I say to my friend "we'll come back tomorrow when it's quieter"." Read into that what you will.
- slurgfest 14y ago
  Seems clear that if this is a real problem, then there needs to be a system to siphon off those people so they aren't clogging up the ER for those concerns.
edoloughlin 14y ago
But ERs already have a system to limit 'abuse' by people with minor complaints: triage.
- chris_wot 14y ago
  Actually, triage is to ensure that those who have the most life threatening conditions are treated first. So you might have a life threatening condition that will kill you in an hour, but a gun-shot victim might die immediately. He goes in front of you.
antihero 14y ago
Yeah but in the UK, we go to our GP for such things and it reduces the load on A&E
- DanBC 14y ago
  Some people go to their GP and that helps reduce the load. But see the need for out of hours doctors clinics being placed in the same place as A&E units - Swindon has electronic signs telling you the estimated wait times for each unit, with big signs telling you where out of hours doctors unit is. Continuing to remind people about pharmacists, NHS_Direct, GPs, and out of hours GPs is helping reduce pressure on the NHS, but still. See also the gently cheeky "Acute admission units" - a method for A&E units to avoid the penalties for keeping people longer than 4 hours by cycling people out of A&E and into aau for monitoring and then release or admission into hospital proper. Over the past 5 years I have seen many A&E units; and spent many many hours in them. They have all been very busy, and often with many people who probably didn't need to be there. (Although I have no way on knowing that; I am not a doctor and I have no medical training and there's no way of telling just by looking at someone if they should be there or not.) The most serious problem in all of them was people turning up for things that were very minor - a splinter; a bruised ankle; some other very minor injuries. These are the kind of things that may need treatment, but you don't need to go right that instant to hospital. I didn't even mind the people who were waiting quietly, but you hear people grumbling about the wait times. I'm not sure they realised that there are minors, majors, and resus, and that if there are 8 ambulances outside it's likely that majors is chock-a-block and all the clinicians are a bit busy tonight.
  - antihero 14y ago
    Why don't they categorise people into priorities so someone comes in with a broken arm, they get seen faster than someone with a graze? Perhaps this could be solved algorithmically.
    - DanBC 14y ago
      They do triage. But someone with a broken arm is in a lot of pain; someone with X is at risk of death. And if you have people that need to be triaged that's one less nurse for treatment (because they're triaging) and the triage queue gets long. And the people with a graze are likely to have to wait a very long time, because (for some reason) it's not acceptable to tell people to go and see someone more appropriate. These people also count against the hospital for the 4 hour wait limit for A&E patients.

by lgbr 14y ago

neurotech1 14y ago

Your blaming the patients, without considering the lack of primary care in the US. Some HMO "covered" Primary Care Providers(Physicians) have a 2-3 week wait for an appointment etc. Certain hospitals have "express care" or "urgent care" on premises, that will treat patients without insurance, same as the ER. Santa Clara Valley Medical Center has a pretty efficient "express care" clinic.

dinkumthinkum 14y ago

But your logic here is flawed. People go to the ER for those things, which are normally legitimate problems, because they can't afford to go to a regular physician. It's sort of ironic that you would pick this example. The idea that health care here really isn't expensive outside of ERs ... is just kind of ridiculous. I think it would be a better argument to say "I don't care about them, screw them if they can't pay" than to use this reasoning -- at least it has the potential for being realistic.

FireBeyond 14y ago

Firefighter / paramedic (/ IT geek) here: I took a patient today out of the ER (via ambulance) to a skilled nursing facility. There were a lot (for us, 6+) ambulances in the receiving bay. Patient comments: "Wow, busy. Usually when I'm going to the ER, and I see that many ambulances, I say to my friend "we'll come back tomorrow when it's quieter"." Read into that what you will.

slurgfest 14y ago
Seems clear that if this is a real problem, then there needs to be a system to siphon off those people so they aren't clogging up the ER for those concerns.

edoloughlin 14y ago

But ERs already have a system to limit 'abuse' by people with minor complaints: triage.

chris_wot 14y ago
Actually, triage is to ensure that those who have the most life threatening conditions are treated first. So you might have a life threatening condition that will kill you in an hour, but a gun-shot victim might die immediately. He goes in front of you.

antihero 14y ago

Yeah but in the UK, we go to our GP for such things and it reduces the load on A&E

DanBC 14y ago
Some people go to their GP and that helps reduce the load. But see the need for out of hours doctors clinics being placed in the same place as A&E units - Swindon has electronic signs telling you the estimated wait times for each unit, with big signs telling you where out of hours doctors unit is. Continuing to remind people about pharmacists, NHS_Direct, GPs, and out of hours GPs is helping reduce pressure on the NHS, but still. See also the gently cheeky "Acute admission units" - a method for A&E units to avoid the penalties for keeping people longer than 4 hours by cycling people out of A&E and into aau for monitoring and then release or admission into hospital proper. Over the past 5 years I have seen many A&E units; and spent many many hours in them. They have all been very busy, and often with many people who probably didn't need to be there. (Although I have no way on knowing that; I am not a doctor and I have no medical training and there's no way of telling just by looking at someone if they should be there or not.) The most serious problem in all of them was people turning up for things that were very minor - a splinter; a bruised ankle; some other very minor injuries. These are the kind of things that may need treatment, but you don't need to go right that instant to hospital. I didn't even mind the people who were waiting quietly, but you hear people grumbling about the wait times. I'm not sure they realised that there are minors, majors, and resus, and that if there are 8 ambulances outside it's likely that majors is chock-a-block and all the clinicians are a bit busy tonight.
- antihero 14y ago
  Why don't they categorise people into priorities so someone comes in with a broken arm, they get seen faster than someone with a graze? Perhaps this could be solved algorithmically.
  - DanBC 14y ago
    They do triage. But someone with a broken arm is in a lot of pain; someone with X is at risk of death. And if you have people that need to be triaged that's one less nurse for treatment (because they're triaging) and the triage queue gets long. And the people with a graze are likely to have to wait a very long time, because (for some reason) it's not acceptable to tell people to go and see someone more appropriate. These people also count against the hospital for the 4 hour wait limit for A&E patients.