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Archive for Saturday, July 3, 2010

Health care overhaul may mean longer ER waits

July 3, 2010

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— Emergency rooms, the only choice for patients who can’t find care elsewhere, may grow even more crowded with longer wait times under the nation’s new health law.

That might come as a surprise to those who thought getting 32 million more people covered by health insurance would ease ER crowding. It would seem these patients would be able to get routine health care by visiting a doctor’s office, as most of the insured do.

But it’s not that simple. Consider:

• There’s already a shortage of front-line family physicians in some places and experts think that will get worse.

• People without insurance aren’t the ones filling up the nation’s emergency rooms. Far from it. The uninsured are no more likely to use ERs than people with private insurance, perhaps because they’re wary of huge bills.

• The biggest users of emergency rooms by far are Medicaid recipients. And the new health insurance law will increase their ranks by about 16 million. Medicaid is the state and federal program for low-income families and the disabled. And many family doctors limit the number of Medicaid patients they take because of low government reimbursements.

l ERs are already crowded and hospitals are just now finding solutions.

Rand Corp. researcher Dr. Arthur L. Kellermann predicts this from the new law: “More people will have coverage and will be less afraid to go to the emergency department if they’re sick or hurt and have nowhere else to go. ... We just don’t have other places in the system for these folks to go.”

Kellermann and other experts point to Massachusetts, the model for federal health overhaul where a 2006 law requires insurance for almost everyone. Reports from the state find ER visits continuing to rise since the law passed — contrary to hopes of its backers who reasoned that expanding coverage would give many people access to doctors offices.

Massachusetts reported a 7 percent increase in ER visits between 2005 and 2007. A more recent estimate drawn from Boston area hospitals showed an ER visit increase of 4 percent from 2006 to 2008 — not dramatic, but still a bit ahead of national trends.

“Just because we’ve insured people doesn’t mean they now have access,” said Dr. Elijah Berg, a Boston area ER doctor. “They’re coming to the emergency department because they don’t have access to alternatives.”

Crowding and long waits have plagued U.S. emergency departments for years. A 2009 report by the Government Accountability Office, Congress’ investigative arm, found ER patients who should have been seen immediately waited nearly a half-hour.

“We’re starting out with crowded conditions and anticipating things will only get worse,” said American College of Emergency Physicians president Dr. Angela Gardner.

Federal stimulus money and the new health law address the primary care shortage with training for 16,000 more providers, said Health and Human Services Department spokeswoman Jessica Santillo.

But many experts say solving ER crowding is more complicated.

What’s causing crowding? Imagine an emergency department with a front door and a back door.

At the front door, ERs are strained by an aging population and more people with chronic illnesses like diabetes. Many ERs closed during the 1990s, leaving fewer to handle the load. The American Hospital Association’s annual survey shows a 10 percent decline in emergency departments from 1991 to 2008. Meanwhile, emergency visits rose dramatically.

At the back door, ER patients ready to be admitted — in hospital lingo, ready to “go upstairs” — must compete for beds with patients scheduled for elective surgeries, which bring in more money. “If you’ve got 10 ER patients and 10 elective surgeries,” Kellermann asked rhetorically, “which are you going to give the beds to?”

That’s why easing crowding will take more than just access to primary care. It also will take hospitals that run more efficiently, moving patients through the system and getting ER patients upstairs more quickly, Kellermann said.

Comments

Richard Heckler 4 years, 5 months ago

People who will be able to receive primary care will not be showing up at hospitals any longer. Why would they go there? The USA insurance industry is at it again.

Waiting has always been a part of medical care. Making appointments then waiting for that day to come has been part of the process for decades. Then many times we wait after we arrive which is why clinics are designed with waiting rooms.

USA Corporate medical insurance is the most inefficient and expensive in the world. Most policies are limited coverage with high deductibles before the policy kicks in in spite of the thousands paid out on premiums. Those thousands would be better spent on an investment or a savings account that would not deny a patient medical care.

Think about how many thousands is shelled out annually for insurance premiums.

Then think about how many times we visit doctors or NOT.

Then think about your $5,000 - $10,000 deductible before any help from the insurance industry kicks in. Why are you paying premiums?

Most healthy families or individuals will never spend $5000-$10,000 a year. If one can afford $5000-$10,000 out of pocket each year why have insurance coverage? Insurance policies guarantee nothing. Consumers can be cancelled any time let's not kid ourselves.

If one has a insurance policy remember this:

Thursday, June 25, 2009

Health insurers have forced consumers to pay billions of dollars in medical bills that the insurers themselves should have paid, according to a report released yesterday by the staff of the Senate Commerce Committee.

Insurers make paperwork confusing because "they realize that people will just simply give up and not pursue it" if they think they have been shortchanged, Potter said.

More on this story: http://www.washingtonpost.com/wp-dyn/content/article/2009/06/24/AR2009062401636.html

Richard Heckler 4 years, 5 months ago

Healthcare-NOW! Members Oppose Current Version of Congressional Health Bill

Over 125 Healthcare-NOW! members at our 2009 strategy conference voted to oppose the current Congressional version of health insurance reform legislation. While we recognize that many of our allies and supporters may disagree about specific aspects of the pending legislation, we believe that, taken as a whole, it is not worthy of our support. In fact, most of the so-called reforms contained in the bills have already been tried and proven to be a failure at the state level in Massachusetts.

Instead, we should act based on evidence of what works. Medicare, with its lower administrative costs and higher rates of satisfaction, remains the “gold standard” for real healthcare reform.

We anticipated the healthcare debate this year would focus on the true stakeholders: patients and those who care for them. But improved Medicare for All (single-payer) was pushed off the table, by Congress and the private health industry, preventing the American people from learning how access to quality, universal care can be financed without increasing cost to the public.

http://www.healthcare-now.org/healthcare-now-members-oppose-current-version-of-congressional-health-bill/

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Senate Tweaks Away YOUR Health Care

By Donna Smith CommonDreams, December 11, 2009

As my grandmother used to say, “I was born on a weekend but not last weekend.” The latest insult to Americans hungry for a bit of healthcare justice for all comes from the news that the Senate health bill now allows insurance companies to place annual limits on payments for some catastrophic illnesses, like cancer.

Surprise, surprise, surprise. Another day. Another lie uncovered in the process. Another piece of this reform bill that favors the for-profit health insurance industry.

Associated Press' Ricardo Alonso-Zaldivar, " [The] health care loophole would allow coverage limits:" A loophole in the Senate health care bill would let insurers place annual dollar limits on medical care for people struggling with costly illnesses such as cancer, prompting a rebuke from patient advocates.

http://www.pnhp.org/news/2009/december/senate-tweaks-away-your-healthcare

http://www.commondreams.org/view/2009/12/11-7

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