More than half of the 354 million doctor visits for acute care made each year are not with a primary physician and more than one quarter take place in the emergency room.
Acute Care in the ER… Expensive and Wasteful
Acute medical care is generally a flare-up of a previous condition or a sudden onset of symptoms like cough, sore throat, stomach problems, respiratory illness, fever, etc.
A New York Times article details the problem of wasted time and money. Among the uninsured, more than half receive acute care in emergency rooms, which are required to screen all and treat those whose lives are in danger. Each visit increases the workload and financial burden of hospitals. Basic care provided through the hospital emergency rooms adds to long wait times, increased expenses, and for the uninsured, not much access to important follow-up care.
Two-thirds of acute care visits to emergency departments take place on weekends or after office hours on weekdays. With few primary care doctors to go around these days, many have schedules that do not allow for same-day visits for acute care.
Primary care doctors generally stick to a Monday through Friday 9:00 a.m. to 5:00 p.m. schedule, precisely the hours when most of their patients are working. For those who work without paid sick days, that is no small matter.
Unfortunately, the uninsured and even the under-insured often have nowhere to turn but the emergency room.
The Affordable Health Care Act is expected to increase reimbursement for primary care practitioners, improve incentives for medical students, and expand community health centers, but authors of the study warn that it may not be enough.
“I’d also note these sentences, which pose a problem for the view that in America, all care is speedy and convenient because we don’t live in a socialist hellhole: ‘One survey reported that 87 percent of primary care practitioners in the United Kingdom and 95 percent in the Netherlands manage patients after hours without referring them to emergency departments. In the United States, only 40 percent of primary care practitioners see patients after hours.’”
Defensive Medicine Costs
Another study published in the journal Health Affairs estimates that medical-liability and defensive medicine are taking a smaller bite of our health care dollars than previously thought, adding $55.6 billion to the cost of health care for Americans in 2008. That’s about 2.4 percent of total health care spending. More than $45.6 billion was attributed to defensive medicine — doctors ordering unnecessary tests and procedures to protect themselves from potential malpractice lawsuits.
A Medscape article points out that a 2007 study by the National Center for Policy Analysis estimated that the annual cost of defensive medicine alone was between $100 billion and $178 billion in 2005, while a 2006 study by PriceWaterhouseCoopers reported that the cost of malpractice insurance and defensive medicine topped $200 billion.
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