Clinic of Last Resort — the ER

erdoorDeath can be caused by not having a car.   If a sick person does not have transportation the effects can be serious.  And, lack of insurance makes the problem worse.

A new study reported in Health Affairs  finds closure of inner-city ER facilities causes more deaths.  Poverty, advanced age, immigrant status, and lack of insurance were correlated with the increased mortality.

Poor people count on the ER as the clinic of last resort — our health system is designed that way — call an urgent care clinic and ask what services are available — “it depends on your insurance” is the answer — “you better go to the ER” is the advice if you have Medicaid or don’t have insurance.

Why wait until the last minute?  Because, there is always hope the health problem will get better, the chest pain will subside, the blood in the stool will stop or the arm weakness will vanish.  Once the heart attack hits, the bleeding is worse,  or the whole side of the body is paralyzed  the chances of death are much higher.

If you don’t have money one of the greatest concerns is NOT getting admitted — how do you get home, how do you pay for outpatient medications and how do you pay for the ambulance ride ($1000)?  The logic is simple: wait until you are REALLY sick.

The ambulance-to ER-to-operating-room is usually a very profitable supply-line of patients, so lots of resources have been lavished to make the system work.  If the ambulance-to-ER system brings diabetes, pressure ulcers and urine infections it drains a hospital’s resources, and finally leads to ER closure.

A good health system would provide transportation, guaranteed urgent care, medications and transportation home for a low-cost package price.  The unloading of the ER might actually save the ER, save patients with true emergencies, and save poor patients who get care earlier.  Wow — and what if that urgent care center was right next to the ER so if there really was an emergency it could be handled.

But no, all that would require planning and a health system where hospitalization was an overhead expense, not a profit center.  So, the only viable solution in the US:   include vouchers for ER visits with Cadillac  purchases or golf club memberships.

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