Emergency Care Needs Emergency Care
Suppose you don’t have a health plan because your employer or your government don’t provide one and you don’t carry personal insurance.
You get sick — so what do you do? Easy — you do nothing. Tough it out.
But what do you do when your kid wakes up with asthma? Or when you finally get good and sick? Well, you head for the local emergency room. Why? Well, it’s open — and they pretty much treat all comers. Sure they lose money — and they are not really set up for sub-acute medicine, but at least you can get an quick exam and some medicine.
Does this really happen? These guys cite the National Center for Health Statistics to the effect that half of all ER visits are for non-urgent care. My experience with the nation’s largest HMO suggests that the number was at least that high a decade ago.
Now suppose that you run the local hospital — and the place is losing money thanks to the cost of indigent care in the emergency room. So what do you do? Well, eventually you open an urgent care center and hope that its costs are lower. Often you close the emergency room. The remaining ERs get more crowded and lose more money, so pretty soon they close.
The system collapses. Is this actually occurring? The Institute of Medicine released three reports last month, after studying the question for two years. Its conclusion, as summarized by the Washington Post:
Emergency medical care in the United States is on the verge of collapse, with the nation’s declining number of emergency rooms dangerously overcrowded and often unable to provide the expertise needed to treat seriously ill people in a safe and efficient manner.
The reports — on hospital ERs, on pediatric emergency care and on pre-hospital care given by ambulance services — were embraced by the 24,000-member American College of Emergency Physicians, and its president said that the endorsement was telling.
"What other industry says, ‘Hey, look at us, our whole system is broken’?" said the group’s president, Frederick C. Blum, a physician in Morgantown, W.Va.
Two key steps for improving emergency care are regional planning and creating a standard way to measure outcomes, so that low-quality ERs and ambulance services can be identified and fixed, the committee wrote.
Emergency medical care is a legal right for all Americans. Under a law enacted in 1986, emergency rooms must evaluate and stabilize anyone who shows up. That requirement — bolstered by physicians’ ethical duty to treat the ill — has made hospital emergency departments subject to unique pressures.
The underlying cause of this crisis is well understood: the report notes that from 1993 to 2003, the U.S. population grew by 12 percent but emergency room visits grew by 27 percent, from 90 million to 114 million. In that same period, however, 425 emergency departments closed, along with about 700 hospitals and nearly 200,000 beds. The Bush administration has responded in characteristic ostrich-like fashion, not by addressing the cause of our ER emergency and not by increasing funding for emergency rooms, but by reducing the care that ERs are required to provide!
The emergency room emergency is a national scandal. It results in the needless death of Americans every day. It makes a car accident or a heart attack more life-threatening than is medically necessary. And it makes a cruel joke out of efforts to plan a medical response to a real public emergency like a flu pandemic, catastrophic earthquake, or terrorist attack.
Message to Democrat and Republican health care reformers: exploit this issue. Explaining to Americans that we have no health care safety net, whether or not we have insurance, can be a very effective wake-up call.
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