Who is to blame for health crisis?

From the San Francisco Chronicle (an editorial):

A recent study showing that uninsured and illegal immigrants shouldn’t be blamed for the nation’s overcrowded emergency rooms begs the question: Who should be?

The Center for Studying Health System Change analyzed about 46,000 people in 12 communities. They discovered that communities with high numbers of uninsured and immigrant residents tended to have lower rates of emergency-room use, while those with low numbers of uninsured and immigrant residents tended to have higher rates. In doing so, they’ve killed the argument that denying hospital access to illegal immigrants will improve our pitiable health-care system. But it points to a sobering conclusion about the quality of care for all patients — including the insured.

Instead, the people clogging the ER are the insured who can’t reach their regular doctor. Cunningham found that communities with fewer or busier doctors tended to have higher rates of ER use. It makes sense — ERs are open 24 hours a day, 7 days a week. Unlike at a regular doctor’s visit, patients can receive a diagnosis, testing and treatment all at once. With the health-care system’s other constraints — community-hospital closures, a shortage of health-care workers and a growing elderly population — it’s no wonder that the insured are flooding into ERs, frustrated by the outpatient system. But if choices for the insured have grown this limited, imagine how things are for everyone else. Illegal immigrants and the uninsured are easy culprits for our health crisis. Unfortunately, the real cause is harder to see.

County to limit access to ERs

From the Houston Chronicle:

Harris County’s public hospitals are about to tighten access to their emergency rooms, which for decades have served as the doctor’s office for some patients with noncritical medical needs.

On Tuesday, what has been an open-door policy at Ben Taub and LBJ hospitals will become stricter.

To reduce emergency room overcrowding, the hospitals for the county’s needy will begin screening adult patients and requiring those who don’t need urgent care to seek treatment in community health clinics.

“We’ve been enabling primary care treatment in emergency rooms, but not liking it,” said Bryan McLeod, spokesman for the Harris County Hospital District. “So what do we do to change things? This is one of those options.”

Patients who go to the county’s emergency rooms with nonurgent symptoms sometimes wait 12 hours or more for treatment.

Waits also are long and scheduling difficult at clinics. But there will be an incentive for seeking treatment in the appropriate setting: money.

After evaluating patients who come to the emergency room, nurse practitioners or physician’s assistants will inform those with nonurgent symptoms that they can seek treatment at a specific community health clinic.

Patients who insist on staying will have to pay a $150 deposit before being treated in the emergency room or an $80 deposit to be seen in urgent care centers at LBJ and Ben Taub.

These are comparable to private minor emergency centers that treat non-life-threatening trauma and illness.

The district is beefing up the urgent care staff at LBJ and expanding the urgent care center’s hours to help treat patients diverted from the emergency room. Construction will begin soon on a $650,000 urgent care center near Ben Taub’s emergency room.

Except for the new deposit requirement, the cost for treatment at district facilities will be on a sliding scale, based on patients’ financial situation, as it is now. Children 17 and younger won’t be subject to the diversion program, though the district will encourage parents to take children with nonurgent symptoms to clinics.