Saturday, September 06, 2014

Coming to Peace with ERs

One wonders how long it will take for the gurus of health care to come to peace with Hospital Emergency Rooms.
Hospital ERs have been bad-mouthed for a long time, accused of disrupting continuity of care, thought to be an expensive substitute for doctor’s office visits, and considered a substandard form of primary care used by the indigent and the uninsured.         
Against the background of that mythology, it was widely predicted that when the uninsured obtained coverage under Obamacare they would establish relationships with primary care physicians and the use of ERs would decline. 
That prediction is turning out to be wrong.  A recent indication of that is included in a Modern Healthcare article (Two Americas, August 18) comparing two similar hospitals, one in Oregon, which has adopted Obamacare’s expansion of Medicaid, and the other in Tennessee, which has not.  In the Tennessee hospital, ER use has increased by 2% but in the Oregon hospital it has gone up by 10%.  The conclusion has to be that when people obtain insurance, they use ERs more, not less.
The basic math is not very complicated.  There are 168 hours in a week.  Doctors’ offices are open something like a fourth of those, and then primarily by appointment.  Illness strikes and injuries occur without regard to the clock.
The attractiveness of medical care made available 24/7 without advance appointment ought to be obvious but its perceived competition with private practice medicine has caused it to be ignored – even denied.  Facts will eventually force that to change and when it does perhaps attention can be focused on improving the service rather than on discouraging its use.

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