The Emergency Room and Health Care Costs
I had the great joy of spending a few hours in a local emergency room with my soon-to-be five year old son last evening after he crashed into the mantle 'practicing football' in the house in opposition to every admonition his mother and I have given him about this activity. After about 2.5 hours and 6 stitches in his forehead, we were on our way home again, mostly 'as good as new'. The experience was excellent given the circumstances.
We arrived at the ER at almost the perfect time. There were two kids ahead of us, and shortly after we registered, more people started showing up, and I had a few minutes to observe most of them. Within about 20 minutes, we were moved on it to our room, where we began the whole treatment process.
When it came time to do the actual sutures, I had some time to speak with the nurses as they prepared both their equipment and my son for the coming procedure. I commented to them that I was struck by how many people in the ER waiting room appeared to have absolutely nothing wrong with them, in contrast to my son, who had a 3/4" bleeding gash on his forehead. The two nurses looked at each other and laughed. One said "You'd be amazed. Most of them probably don't have much wrong other than a headache, fever or sniffles." When I asked if this was normal, she said "Yes, it's really common. Monday is especially bad. Most of the free clinics are closed over the weekend, and because of that, Monday appointments at them are tough to get, so they end up coming here".
I then asked "Are these my tax dollars hard at work?", to which she replied, "Just try not to spend too much time thinking about it. It'll drive you absolutely crazy when you realize how much money is being poured into ER care of things that can easily be taken care of at home. I've stopped telling my husband about it, because it just infuriates him."
My question about what could/should be done about this was met with a strange indifference until one of the nurses left the room. The remaining nurse said "Sure there's something that can be done, but no one wants to talk about it. Everyone, and I mean everyone, needs to pay SOMETHING. We need to get rid of totally free care and increase co-pays. When someone who has a kid with a headache realizes that they might have to pay $25 for an ER visit, they're very likely to go down to the drugstore and get an $8 bottle of children's Tylenol and treat that headache at home. Right now, there's no cost incurred for coming in here but their time, so why not save the $8?" At that point, the other nurse returned, and our conversation about the "thing that must remain unspoken" ended.
I know that when I began working on my own and took out a high deductible major medical policy, my wife and I, who were never 'arbitrary' users of the health care system, were even more conscious of our decisions to seek medical care for our family. Given this, I've always thought that increased co-pays would make a huge difference, but I've never had it confirmed in such a direct way.
I know it's but one experience, but such common-sense policies, while politically difficult, will likely make a huge dent in our out-of-control health care costs.
We arrived at the ER at almost the perfect time. There were two kids ahead of us, and shortly after we registered, more people started showing up, and I had a few minutes to observe most of them. Within about 20 minutes, we were moved on it to our room, where we began the whole treatment process.
When it came time to do the actual sutures, I had some time to speak with the nurses as they prepared both their equipment and my son for the coming procedure. I commented to them that I was struck by how many people in the ER waiting room appeared to have absolutely nothing wrong with them, in contrast to my son, who had a 3/4" bleeding gash on his forehead. The two nurses looked at each other and laughed. One said "You'd be amazed. Most of them probably don't have much wrong other than a headache, fever or sniffles." When I asked if this was normal, she said "Yes, it's really common. Monday is especially bad. Most of the free clinics are closed over the weekend, and because of that, Monday appointments at them are tough to get, so they end up coming here".
I then asked "Are these my tax dollars hard at work?", to which she replied, "Just try not to spend too much time thinking about it. It'll drive you absolutely crazy when you realize how much money is being poured into ER care of things that can easily be taken care of at home. I've stopped telling my husband about it, because it just infuriates him."
My question about what could/should be done about this was met with a strange indifference until one of the nurses left the room. The remaining nurse said "Sure there's something that can be done, but no one wants to talk about it. Everyone, and I mean everyone, needs to pay SOMETHING. We need to get rid of totally free care and increase co-pays. When someone who has a kid with a headache realizes that they might have to pay $25 for an ER visit, they're very likely to go down to the drugstore and get an $8 bottle of children's Tylenol and treat that headache at home. Right now, there's no cost incurred for coming in here but their time, so why not save the $8?" At that point, the other nurse returned, and our conversation about the "thing that must remain unspoken" ended.
I know that when I began working on my own and took out a high deductible major medical policy, my wife and I, who were never 'arbitrary' users of the health care system, were even more conscious of our decisions to seek medical care for our family. Given this, I've always thought that increased co-pays would make a huge difference, but I've never had it confirmed in such a direct way.
I know it's but one experience, but such common-sense policies, while politically difficult, will likely make a huge dent in our out-of-control health care costs.
posted by festivus | 12/07/2004 01:40:00 PM
I'm not sure I want to be arguing for socialized medicine or against copays (I am against the first and for the second) but I'm not sure the present situation is as inefficient as Larry thinks. The problem is that our accounting for emergency room costs is extremely screwy. By our flawed accounting system, each time that kid with a headache comes in, it "costs" probably $1000. But does it really? If triage is done right (and I think it is) Larry's wait is pretty much unaffected. That is, if Larry and his son had come in after all the headaches, I think they would have simply been seen first anyway. So I don't see waste on that avenue. What about the size of emergency room operations? If we have twice as many highly trained emergency room doctors and nurses as we really need because of the headache people, then this is a real cost. But do we? I think this depends on how the hospital is reimbursed for the headache people. If the hospital is given a big dollar amount each time, then they have an incentive to increase the size of the emergency room to make money off the headache people. If they are given only a small amount, it makes sense for the hospital to keep the emergency room big enough only for real emergencies and handle the headache people only when they otherwise would be sitting around waiting for car accident victims. I'm not sure this is that wasteful. My guess is that don't get much for the uninsured.
It is hard to be more agreeable about something than Larry's post. Perhaps you should talk a little about the public schools.
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