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Health Care Dollars Wasted in the Emergency Room

Health Care Dollars Wasted in the Emergency Room

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.

From Ezra Klein’s column on the subject:

“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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61 comments

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8:50PM PDT on Mar 15, 2011

What New that doesn't surpise me because I take my 8year son to the emergency room and my insures don't cover nothing

10:03AM PST on Mar 10, 2011

I like that nurse line idea. Actually the 911 system should have something like nurse-line. The dispatcher who receives the incoming calls should quickly sort out the callers who need advice on first aid and/or home nursing and transfer those calls to the nurse line. That will leave the dispatcher with calls from people who really do need professional help promptly.

6:52PM PDT on Sep 15, 2010

Universal health care is needed urgently!

12:35PM PDT on Sep 11, 2010

With the job market the way it is many people are afraid to take time off work so without after care available the ER is the only place to go. I live in a city where ER rooms close too often when overloaded and can't take emergeny patients.
Also, without the expansion of the healthcare act that paid some of the premiums for laid off workers it's going to get worse.
You shouldn't have to go bankrupt to get medical care.

5:47AM PDT on Sep 11, 2010

Mary L I have dealt with both in helping family and frankly the private groups were easier than traditional Medicare. I am glad you haven't had the challenges, YET. Hope you don't.

4:53PM PDT on Sep 10, 2010

In British Columbia we have what is called the "NurseLine". It has been going one for some years now, is paid for by provincial taxes.

One calls the "NurseLine" with medical questions and a Registered Nurse, will answer most of them. If there is any doubt the nurse will transfer the call to a physician, pharmacist or other medical practitioner with specific knowledge.

This has been a great service to us in that it helps cut down on many unnecessary ambulance call outs, unnecessary visits to the ER and saved lives by directing severe cases to hospital if required.

This service SAVES MONEY for us taxpayers by providing quality care.

It is surprising how many people do not have basic knowledge of first aid.

3:05PM PDT on Sep 10, 2010

Chris L.: The nightmare you describe is with private Medicare policies, not traditional Medicare which is all I have. True, it doesn't cover everything but it is slick as a whistle! Not content, the privateers sold the government on the notion the "private companies could do a better job" and so was born Medigap, Medicare Advantage, and the demonic Medicare Prescription Drug "Benefit" that is completely privatized - none offered through Medicare! Even for the poorest, the feds buy drugs from private firms. You don't seriously believe that Tom DeLay pulled out all the stops to pass a law that would not fill the coffers of private businesses, do you? Dig deeper to find the truth.

7:32AM PDT on Sep 10, 2010

Ann the last thing I want is Medicare for all. I have carried private insurance all my life and it is not always roses and wine. However, I have never required assistance in figuring out my coverage. I have always been able to figure out what was covered and what I needed to do to get service.

Why is it that we need senior social workers to help seniors negotiate medicare? It is a bloody nightmare. I have helped several relatives through the process and it is ridiculous the amount of paperwork, the denials, and the petty issues that you go through to get the services that people are supposed to get for the coverage promised. This is what I am supposed to surrender my free market coverage for? Yeah, RIGHT.

THE LAST THING I WANT IS MEDICARE. If there was a way to keep private insurance in my elderly years and avoid government Medicare I would. In fact I don't expect Medicare will be in business when I get there so hopefully there will be a free market option since I suspect Medicare and SS will be things the next generations only read about in history books. I don't ever expect to see a dime of what I put into the system. I do hope that for those that do not have enough time to make alterntavie plans, that the plans last long enough for them to survive.

You truly think Social Darwinism doesn't occur with Medicare? Please dream on. Government health care does not provide unlimited access to all.

7:26AM PDT on Sep 10, 2010

Yes Debbie calling people sexual slurs is such a way to open up dialouge and communication with people you disagree with on issues. You hope by intimidating them they will not have the courage to speak out against you.

Well as for all the elderly in this country that so many of you are angry about we have given them no option but to BE dependent on medicare and SS because we took everything from them to keep it going. So now they have nothing less. Sure ask them to cut off their only source of retirement in order to argue against universal healthcare. Many of them did work towards getting the younger generations the freedom to have tax free options to save for retirement. They also worked to get us Health Care Savings accounts because they realized that having control of OUR MONEY would make us LESS DEPENDENT on the government who tells them how much they are going to get, what kinds of medical services they can get and if they are deserving to continue to get it. Yes, many of them have fought for those of us coming after them to have more options to get off of government dependency in old age. We aren't there yet, but there are many who realize the danger of handing the government total control and becoming dependent on its goodwill towards you to get what you need.

As for complaining about the insurance companies denying care, how is medicare any different? I have never needed help figuring out my insurance coverage, only wish I could say the same for Medicare

12:48AM PDT on Sep 10, 2010

Urgent care clinics have been going out of business for a long time - hospitals too. They weren't profitable enough and our system is about Ins Co & Wall St profits and top execs' multimillion dollar compensation packages, not about health care. They don't treat patients, but take a significant cut of health dollars - middle men taking money that could go to improved access, primary care providers, R&D, health care education grants, preventative care...

The solution would have been a type of Medicare for All in which everyone pays in and is covered, the healthy, sick, young, old - so the risk pool is broad, making it less expensive for all. Instead we had millions from Wall St, Ins Co, Koch, etc. funding astroturf groups. Millions going to convince the gullible to fear "socialism" and "government run health care." Yet how many of them wanted to keep their "SOCIAL" Security and "government" run MEDICARE.

Some are so eager for their health care decisions to be made, not by their doctors, but by those who whose fiduciary responsibility is maximizing investors profits NOT providing care. The higher the premiums and the less care they provide the more money they make. An inherent conflict of interest. Every industrialized country has figured that out. But we have folks eager to join the third world - with no public services, protections, education, health care, safety nets, regulations, oversight... Libertarian = Social Darwinism, or those who want Theocracy.

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