Originally Posted By Mr X I used to think this guy was pretty decent, but he's gone off the deep end lately for sure! <a href="http://thehill.com/blogs/blog-briefing-room/news/83113-pawlenty-let-ers-turn-away-patients-to-cut-costs" target="_blank">http://thehill.com/blogs/blog-...ut-costs</a> ***Emergency rooms should be able to turn patients away to cut costs, Minnesota Gov. Tim Pawlenty (R-Minn.) said last night Appearing on Fox News's "On the Record with Greta Van Sustren" last night, Pawlenty said the federal law that mandates ER treatment should be repealed. "Well, for one thing you could do is change the federal law so that not every ER is required to treat everybody who comes in the door, even if they have a minor condition," Pawlenty said. "They should be -- if you have a minor condition, instead of being at the really expensive ER, you should be at the primary care clinic."*** What Pawlenty doesn't bother to note, however, is that for a vast number of people there IS no "primary care clinic" option. Oh well, let em die I guess.
Originally Posted By SuperDry <<< What Pawlenty doesn't bother to note, however, is that for a vast number of people there IS no "primary care clinic" option. >>> There are options other than using the ER for primary care. Take for example: <a href="http://www.youtube.com/watch?v=wd-EBG3a7jU" target="_blank">http://www.youtube.com/watch?v...EBG3a7jU</a>
Originally Posted By davewasbaloo This is what happens when health care is marketable commodity. In the UK, and ER interventions costs an average of $80,000 however, to be fair, this is a mean average as some interventions (like checking a rash or something is cheap, while emergency surgery or tests can be very expensive). Compare it to a general primary care practice intervention which is about $30, part of what he is saying makes sense. However, only if you drive the systemic change to make primary care free (or at least afordable).
Originally Posted By SuperDry So, in the UK, given universal coverage, how is ER care managed? In the US, part of the problem with ER care is that many people that are uninsured go to the ER for routine care because they cannot be turned down. But, separate from that, I'm personally familiar with situations in the US where people with the best of insurance policies still take their kids to the ER for something that would normally be handled by their GP just because the events happen after-hours. For example, if a toddler develops a fever, the parent might take them to the doctor's office if it happens at 10am, but at 10pm, there's nowhere else go to but the ER. Fortunately, over the last few years, the notion of 24x7 private clinics and even private "emergency rooms" outside of hospital settings have developed that have partially offset this issue, but it's still an important issue that must be dealt with.
Originally Posted By davewasbaloo Sadly it does depend where you live. Currently ER (or A&E - Accident and Emergency as it is called here) is still often used in this way out of hours or on Sundays. However, we have a great service called NHS Direct which is fab for non emergencies. You can go online to look up symptoms or use the phone lines. They will take you through an assessment and advise the best course of action. They will advise whether it is something you can treat at home (though they are very cautious with this), or whether it can wait and suggest you go to your GP, or whether you need to go in immediately. If immediate, they can advise whether you go to the hospital or whether your GP might be able to make a house call. And now we are developing poly clinics, one stop shops for medical and social care that are located in neighbourhoods, many being a 24/7 service. But if someone goes to ER, they are treated in the same way as the US pretty much. A triage nurse will register them and then they wait to be seen according to severity. If it is something that was self treatable or advisable to go to the GP instead, the Doctor will tell the patient while examining them. If it is a regular occurance of someone going in rather than their GP, they may take a more direct approach of offering health training to help people better understand the care pathways. But overall, we tend to take a view that it is better for someone to seek help early than let something fester (except for some stupid maternity units). For example, HIV and Chlamydia screening, you can go to any drop in clinic anywhere and get tested. It is annoying and the recharge process behind the scenes is a night mare, but the view is at least we can stem the epidemiology, and that is a good thing.
Originally Posted By KatieKate123 My mother is a Er nurse and they get tons of stupid people coming in for colds b/c they don't have a primary doctor. The problem with this is those people don't pay the bill that comes home so the drs are losing money on these stupid people. So in a way I think that the Er should be able to turn people away who are not Emergency's and they do this in a way by making these people wait hours. Those people should go to the clinics and they have them in all cities. They have free clinics, or those day clinics.
Originally Posted By Sport Goofy ^^ Or, maybe we should provide a way for these people to get insurance so that they can go to a primary doctor instead! Contrary to popular opinion of the wealthy folks on the right, it's not the poor that are without insurance. We have Medicaid programs to take care of those folks. The largest population of uninsured people reside among the middle class with jobs. Unfortunately, their employers don't provide insurance and they can't get it on the private market due to things like pre-existing conditions or prohibitively expensive premiums. Health care reform isn't about insuring the poor -- we already do that. The reform we need to achieve would deliver care to the millions of working Americans who are shut out of the current system due to the greed of the health care industry.
Originally Posted By SingleParkPassholder More and more, we are seeing motions in court where the non-custodial parent is asking to be relieved by the court order to provide health insurance. The relevant code section says they are to provide it if it is available through an employer at reasonable or no cost. Reasonable cost is defined as being available through an employer as opposed to buying it on their own. Our courts have been granting the motions more and more because the parent is able to show his or her employer doesn't offer it anymore, or the cost is so prohibitive as to be unreasonable. So, the kids go without. We would refer many of them to Healthy Families, a state run concern, but the governor's proposed budget wants to eliminate that as well. Good times.
Originally Posted By skinnerbox <<"They should be -- if you have a minor condition, instead of being at the really expensive ER, you should be at the primary care clinic.">> Problem is, in HMO systems like Kaiser Permanente, those "primary care clinics" have made their urgent care/injury centers by appointment only. And those same-day appts are always gone by noon. The urgent care/injury center at my local KP clinic used to be walk-in, 24/7. You usually had to wait an hour, but you would be seen eventually. And if you had a bleeding wound that needed sutures, you got in sooner. But not now. If you don't have an appt, you MUST go to the ER, no matter how minor the illness or injury. If you have a sprained ankle you think might be broken, or a really painful bladder infection that you think might be a kidney infection, you have to go to the ER and wait three times as long for the exact same treatment you'd receive at Urgent Care, if they were still taking walk-in patients. Not to mention -- and this is important -- spend four to ten times more in a higher co-pay for the ER versus a much cheaper co-pay for Urgent Care. Did you catch that last part? That's the primary reason KP switched Urgent Care to appts only, with fewer operating hours. Walk-in care is now only available in the ER, which is as slow as molasses at a much higher co-pay. KP needs to staff the ER continuously 24/7, so it doesn't cost them any more money to funnel their members through ER for their urgent care needs. They don't staff the ER with more personnel; they just make everyone who doesn't have serious emergencies wait much longer for care, at a higher cost. More $$$ in Kaiser's pocket... fewer hours of your life to live outside the hospital. And trust me on this one. When you're sick with H1N1 and severely dehydrated from vomiting and diarrhea, those two hours in the waiting room on uncomfortable chairs with everyone sharing ONE UNISEX RESTROOM, is not fun. Urgent Care has a better waiting area, with multiple restrooms for men and women that are cleaner, and staff which isn't overworked and stressed out from dealing with too many patients and too few beds. Pawlenty is a pandering jerk for the most part, but the point about using primary care centers for non-emergency medical needs is sound. Too bad that one of the largest HMO organizations in the country doesn't feel the same way, and all in the name of cost cutting at the out-of-pocket expense and convenience of its members.
Originally Posted By Sport Goofy <<"They should be -- if you have a minor condition, instead of being at the really expensive ER, you should be at the primary care clinic.">> I've related this story before, but it's worth repeating. Back in 2008, I was traveling across the country with my work. As I bounced from city to city, I needed to find a place to get my monthly allergy shot. When I got to the city of Milwaukee I ran into a problem. I couldn't find any doctor's office who would accept my insurance. That's fine, I thought. I'll just pay cash. I don't pay a cent for my medical care, so what's the big deal of paying to get a shot for once? Well, it wasn't that easy. It turns out that all of these doctors offices had a no-cash policy. They only billed through insurance and no one would let me get the services I needed by paying directly. I am pretty conscientious about these things -- I started making the phone calls weeks in advance. I called every possible clinic that I could to try an arrange an appointment that met my needs. Here's the kicker. Every time I tried to schedule this routine appointment for an allergy shot I was advised that my best option would be to go to the emergency room to get this done. The ER! That's what the primary care clinics and allergy clinics were recommending because I didn't have the insurance plan they would accept! Well, it turns out I'm pretty resourceful. I finally found a doctor who wanted something that I had to barter. I didn't pay cash, but I exchanged something of value that the doctor wanted. That was fine by me, but what a bizarre way to run a health care system!
Originally Posted By Kar2oonMan >>I finally found a doctor who wanted something that I had to barter. I didn't pay cash, but I exchanged something of value that the doctor wanted.<< A Klondike Bar?
Originally Posted By Mr X I find it funny that you'd actually have to make a trade, whereas a simple cash transaction is somehow unseemly.
Originally Posted By Sport Goofy It wasn't funny at the time. It was pretty darn frustrating. Anyway, I fortunately had tickets to an event the doctor was interested in attending, so I got my allergy shots as scheduled. 4 weeks later, I was in Canada. I didn't have to worry about insurance, money, bartering, or even scheduling an appointment. I made a phone call, was seen the same day, and given completely free treatment even though I'm not even a citizen. What a difference a trip across the border makes!
Originally Posted By Mr X I'm sure it was frustrating. <--was wondering what the heck you had for trade that someone would want!
Originally Posted By SpokkerJones "I finally found a doctor who wanted something that I had to barter. " Same here. I was gave a handy for a blood test.
Originally Posted By SpokkerJones "I find it funny that you'd actually have to make a trade, whereas a simple cash transaction is somehow unseemly." The great capitalist society reduced to barter. "What a difference a trip across the border makes!" I have to wonder, though, Canada has had this system for a while now, right? What has the funding situation been? What's the forecast? Is it expected to be sustainable? Is it going to go bankrupt like our system or what? You don't really think of Canada as imploding anytime soon. They seem pretty stable up there.
Originally Posted By Sport Goofy << I have to wonder, though, Canada has had this system for a while now, right? What has the funding situation been? What's the forecast? Is it expected to be sustainable? Is it going to go bankrupt like our system or what? >> Our current U.S. system goes bankrupt in 2018. It can't get worse than that.
Originally Posted By fkurucz >>Health care reform isn't about insuring the poor -- we already do that. The reform we need to achieve would deliver care to the millions of working Americans who are shut out of the current system due to the greed of the health care industry.<< Hear, hear! And that ranks of the uninsured middle class will only continue to swell.
