Frequent trips to ER -- news story

There is an old rule called the 80/20 rule, that 20% of people will use 80% of a resource. Seems like when it comes to medical care its even more skewed.

http://news.yahoo.com/s/ap/20090401/ap_on_re_us/frequent_er_patients_3

AUSTIN, Texas – Just nine people accounted for nearly 2,700 of the emergency room visits in the Austin area during the past six years at a cost of $3 million to taxpayers and others, according to a report. The patients went to hospital emergency rooms 2,678 times from 2003 through 2008, said the report from the nonprofit Integrated Care Collaboration, a group of health care providers who care for low-income and uninsured patients.

[ILADVOCATE]

Yes I am familiar with the fact that emergency rooms are overcrowded including personally. The problem is when people lack health care coverage they have no means to pay their doctor so they go to the emergency room for what otherwise would be taken care of by a doctor. Its not what otherwise would be an emergency but it could spiral into such as a child with a running temperature and fever. Doctors do have to get paid but there has to be some form of national health care coverage (as I've posted with a graduated premium) so that people don't avoid medical care and then depend on the emergency room. Many forms of health care coverage are too restrictive as well and some children whose parents do have health care don't have dental coverage and thus can't see the dentist and get cavities that could have been avoided by routine visits if covered. This definitely has to be straightened out.

[peekawho]

I can't even go to my own doctor without paying up front.  If you don't pay, they'll nicely "reschedule" you until you can.

Unfortunately, people then resort to going to the ER, where credit is king.  They go, sometimes they vanish, and then we all pay the difference.

[PlateletGal]

Many physicians are sending their patients to the ER when they don't have time to see them and/or the patient doesn't have health insurance.

We are paying more for less healthcare. Doesn't make sense does it ? I choose for affordable health care coverage for everyone... not just some. It will cost less and cover more.

[HelpinUtah]

I do NOT believe in our government controlling our health care!  However, I do like ideas that have been thrown out there by other politicians that why not find a couple insurance companies who would allow people to join as a group with lower premiums (because of how many people would be involved) and allow them insurance that way.  The premiums would cost very little because of how many would be involved in that group.  It would work similar to a company providing insurance but only better rates.  

Once we allow govenment to control our health care - they will choose who lives and dies.  If we think we have long waits to get into our doctors now - it willl just get worse if the government pays the salary of those doctors and tells you where you can go and which provider you can see in your area.  I don't want to go down that road!  At least, the other way (even with a managed care company) you would have several choices.  

Just my two cents!

[swampcritter]

If you calculate it out, you'll see that these people were going to the ER once a week on average for years...which is a whole different problem than someone going to the ER because the doctor wouldn't see them or just being accident prone for the year.

[PlateletGal]

Who said that I wanted our government to control our healthcare ? What I'm saying is that we have a healthcare crisis and in my opinion, this is a MORAL issue. I believe everyone in this country should have access to affordable healthcare. And in addition to that, it isn't a wise decision to keep letting people get so sick that they get on Social Security.... and pay for their healthcare that way.

[HelpinUtah]

I was actually responding to someone else who mentioned national health care.  I didn't think you were stating that.  I do agree we have a healthcare crisis in this country.  I also agree about Social Security.  I just gave my opinion about how I think it would work best although I'm not an expert.  So, I agree with you!  :)

[ILADVOCATE]

The problem is to take one form of healthcare that was partially privatized which is Medicare is that Medicare Part D is unworkable because of the continuous denials for neccessary medications and the gaps in coverage ("donut hole") that many people have to pay out and can't afford (and note most people recieving Medicare are senior citizens who have already worked and paid into the system and should have complete coverage). Medicare is government health insurance but in last administration it was partially privatized (I'm not debating each administration, I won't comment on president Obama until he develops a workable plan, every president has tried and failed including Clinton). "Managed care plans" are not part of the government but are for profit companies and are very good at controlling people's health care and what they are entitled to with the recipient on the losing side. And I have some knowledge of this issue but if you would want to read factual stories about why its unworkable google "Medicare Rights Center". Its unnerving to hear about people getting denied life sustaining care which was supposed to be improved by partially privatizing Medicare. I can't say I would automatically trust the government (although honestly we should be able to because we elect them) but I would say I would not trust the insurance industry to make the right decision.

[HelpinUtah]

I guess that's where I differ.  I do not trust our government to handle our healthcare!  Look what they've done to our country!  

I had a managed care plan in Pennsylvania for over 10 years and it was the best insurance I have ever had in my life!  So, for me, managed care does work if it's used properly.  Of course, there are always things that are denied, but it wouldn't be any different with the government in charge.

I completely understand about Medicare.  My mother needs a lung transplant but the government (Medicare) says she's too old - only 67!!!!   My mother has been disabled since she was my age now.  She has Medicare and it's not easy.  But, that's where I come in - it's my responsibility to help take care of her and so I do.  Now, I agree not everyone has children that will or can help them and so I agree they need our help.  But, that's different than giving on a national level every person in this country government medical care.  It's too expensive and won't work.  Besides, the government will deny more than managed care does.  I have some experience in this as well!

I sure hope our current administration can come up with the appropriate alternative.  I just don't know that I trust our government being involved in my medical care!

This is definitely a complicated issue.  

[Trialanderror]

Swampy, do you know if those nine people always went to the ER on their own terms? Or are they people who keep getting their health in trouble, maybe if they are homeless, and others keep calling an ambulance for them? I`m just curious if the statistics were specified.

[swampcritter]

All that is known is what is in the article -- they tended to either be drug addicts or they had mental problems. The article does list that some were homeless.

Even if the US had national health care, there will still be people that will continuously show up in the ER like these people. What can be done with them? It used to be, years ago, that a person who was mentally ill could be incarcerated in a mental home. Today, we don't permit that -- and it would be terrible to go back to that system.

[ILADVOCATE]

Yes well that's another issue. One difficulty with someone with a psychiatric disability that is not very treatable (they take their medications as prescribed but still have heavy symptoms and can't work) is that they are constantly being disconnected from the benefits system including Medicaid which without they go without needed mental health care. It is also difficult because there is community housing (supported housing, supportive housing and community residences as needed) but people often don't want it built in their neighborhood even though it reduces homelessness. I'd have to say I am of two mindsets about this. On the way hand I have advocated for people like this on a small and large scale. On the other hand without medical coverage for my treatment that has helped with my recovery I would be one of them. I've never used illegal drugs of course but there are rehabilitation centers for that and they help prevent recidivism. Much could and can be done. People just have to realize recovery is possible, as many people here could personally testify.

[marileew]

"Doctors do have to get paid but there has to be some form of national health care coverage (as I've posted with a graduated premium) so that people don't avoid medical care and then depend on the emergency room."

I completely agree, I live in Canada and we have universal health care and it's something that the majority of Canadians are extremely proud of, take for granted and would absolutely never give up.

But... I wanted to point out, that we have similar problems in Canada... even WITH our universal health care. Some provinces worse than others, some cities worse than others. We have a SERIOUS shortage of GPs in most Canadian cities... especially mine. If your family doctor retires... you are basically screwed. I live in a city of clinics... a city where very few people, only the very lucky, have family doctors. The majority of young people rely on walk-in-clinics and anyone who had a family doctor back in the day but then their family doctor has retired is also in the same situation pretty much.

Also, back in the 80s, my province thought it would be a great idea to trash our mental health care system and close every mental hospital without creating new resources to replace all of the resources they trashed. The moment we shut down our mental health care system, we created a homelessness crisis that is now world-renowned. The homelessness crisis has spiraled out of control and the sub-culture appears to be like a magnet to so many in desperate situations... as there is so much tied up in the sub-culture that is attractive to those at risk (at risk examples: those who have been abused, those who have mental health issues, those who are already low income, those who are minorities...

A side note about the at-risk minorities in Canada... in the past, even recent past, my government has systematically abused minorities, something which we, as a country openly admit to, teach in our schools as truth, and our government has offered apologies for... but, an apology does little to fix years of messed up policy... and even the most racist and abusive government policy takes years to change due to the way policy-making work... and I come from a political background (family in politics) and so I do have much sympathy for the snail-pace slowness of change even if it means that bad policy stays on the books for much longer than it should.

So... in my city... universal health care and all... hospital ER rooms are still used as a substitute for proper general practitioners.  Reasons:

1. Lack of GPs. Created by government caps put on the number of students allowed to enter medical school per year (our higher education is public as well). The schools then institute even more stringent caps. Within the small number of students allowed to enter medical school per year (and this doesn't just go for doctors... the wait-lists for nursing schools and all medical-related technical schools are years long), being a general practitioner doesn't sound very glamorous and is rarely picked... students who do pick to go into family practice are treated as saints among family members, friends and strangers because so few do. Our government is creating more and more programs to try and fight back at this phenomenon... but unless they do something about the pure number of seats available per program, I doubt much will change and our doctor crisis will stay much the same.

2. My city is KNOWN for it's homelessness crisis these days. It is the WORST in Canada. The homelessness crisis is rooted in the fact that our provincial government completely trashed our mental health system with the good intentions of main-streaming mental health patients... although with the lack of foresight to provide them any replacement health care. Instantly we created a homelessness crisis. The homelessness subculture is extremely attractive to ALL of those at-risk... and it has veered from the mental-health crisis it was once in the 80s. Now... it is merely a homelessness crisis. Although, for some reason, we do not provide over-lapping health care to patients in my province... you cannot be treated for mental health if you have a drug problem and you cannot be treated for a drug problem if you have mental health issues. The mental health patients have no real resources... in spite of the fact that our government pours millions of dollars into resources that seem to disappear as easily as those at-risk patients. Those with drug problems are distrustful of the system (for good reason) and the system includes health care. And... the rest of the poor who don't have mental health problems or drug problems are cast off to the side because as a society we have just TOO much to deal with to spend a penny on programs to help those who might still be able to really benefit from intimidate intervention... prior to being forced to go off the temporary disability and onto the permanent welfare and becoming just another lost statistic in my city full of lost statistics. It's a pretty messed up situation.

So... yeah... I do completely agree. Universal health care is a must and there are few Canadians out there you'd find who would willingly give it up... but, it's not the whole solution to keeping emergency services used for emergency situations only. I think the real solution to that one is to have proper access to proper services... something which my city is lacking.

Although... with that said, I do love our walk-in-clinics and our easy access emergency rooms (even if you have to wait 6 hours in a waiting room full of drug over-doses to get a broken arm set) and I wouldn't trade that for almost any other health care system that currently exists in the world... I just wish my government would get it's act together and remove some of the ridiculous caps on medical programs and would re-institute a spectrum of health care systems so that not everything had to get to an emergency level and eventually end up in an emergency room.

[teko]

Did anyone watch 60 minutes last night? People were on the show that had cancer and had been recieving treatment at the county hospital in Nevada. That is, until the county hospital canceled their oncology dept due to lack of funds needed to keep it going. These people were handed a death sentence. Those who had insurance thru their employer but had since had to quit their job due to their illness and could not afford to keep up the insurance? This is really sad! We have finally arrived at letting people die who do not have insurance? I am for national healthcare or anything else that would prevent this from happening. Unless you are in this situation, it is very easy to have opinions on it!

[margypops]

I have lived with Government run health care and socialism, there are huge waiting lists for Surgery and a lot of it is refused any way,you wait weeks for an appointment to see a specialist and days sometimes even to see a doctor, doctors leave UK to work where they get paid it has not worked at all, Yes America does need a better system the insurance companies need to be easier and less expensive, in England ,the ERs are still full as its the only way sometimes.to get anything done when you are sick, dont be fooled ,by the smooth talkers, it doesnt work ,I came to America to escape it..

[PlateletGal]

"but I would say I would not trust the insurance industry to make the right decision."

I agree with you 100%. Physicians trusted HMO's and thought they would help them. What they didn't know at the time that these insurance companies would be denying life saving operations to their patients !  And how about United Healthcare cheating on claims ?


Greed & corruption:

http://www.bloomberg.com/apps/news?pid=20601087&sid=agH.cI_6Ve5I&refer=home

[guessagain]

I lost my job because of issues related to my health and I kept up with the cobra payments while I could qualify. Then because of preexisting conditions, I was now basically uninsurable, but holding my own. I prepay my doctors visits and they give a good discount for paying up front. Although regular work is spotty at best right now, I get by, but single trip to the E.R., 24 hours in the hospital, and some tests raked up nearly $7000.00 for the hospital. Nearly another $800.00 for E.R. doctor fees alone. Wearing a heart monitor for 24 hours $450.00, two office calls $140.00, lab work $90.00, medications 1 month $100.00. Total, $8580.00. I don't really care what kind of health care I get.
    

[margypops]

Well dont count on goverment run health care to make it better all you will do is wait for any treatment ..days maybe a week for a docs appt, surgery .....in definate time.office calls you'll be lucky ...you still pay for meds.Yes ER you may get somewhere .I sympathise.. its a dilemma isnt it , I wish the best health treatment you can get..

[guessagain]

Thanks, I know what you mean though. My ex- father in law was a paranoid schizophrenic and treated under government rules. He became very ill and was hospitalized with pneumonia, he was getting better and the regulations were such that he was to go home on oxygen. He lived alone and was found dead 3 days later. Officials wanted to do an autopsy because it was just too soon after leaving the hospital. He died because of what they called mucus plugs in his lungs. I'm sure things would have been different had he not been mentally ill, but the government programs were pushing him out the door.    

[teko]

My husbands employer dropped the health insurance and as of April 22. we do not have any. After trying to get it on our own we were denied because of risk factor. He has stents and I have emphysema. So much for getting in the door, if your sick! Suggestions?

[ILADVOCATE]

Not sure if they have it in Florida yet but if they do the Medicaid Buy In for Working People with Disabilities is a good option. Google the term. In states that have it (which is increasing) the income and asset restrictions are well within a standard person's income.

[Cherie762]

I agree with Margy../gov health care sounds appealing,,,but I have a really really good friend in Perth Australia who is in horrible pain every single day..she needa s specifc surgery and it is being denied to her causint her health to furter deteriorate,( severly) many months to wait often for any help...I dont think Id want that..

also,,,I thought drug seeking was illegal...why are these repeat  visits not red flagged and dealth with in a legal matter..really dont know the answer ...wondering???

[ILADVOCATE]

I'm not sure if those people were in any way legally not entitled to use the emergency room. Those 9 people may have misused it but that story was focusing on those people to focus on that angle. There are many more people that have no options. The problem is when people don't have health care entirely they use the emergency room for situations that are not emergencies but could turn into such as when their kid has chickenpox or a strep throat. A strep throat could be a quick visit to the doctor but without coverage it could have life threatening complications. I would not want socialized medicine certainly but some form of national health care plan with graduated premiums that people could opt into or out if they wanted to would be fair to me. Healthcare is something everyone should be entitled to. And the entire population benefits when everyone is entitled to healthcare because if yearly check ups and vaccinations were completely covered, for example, the rate of communicable diseases such as influenza (kills 36,000 people a year) would go down. Everyone should be covered. That said people who can should pay for healthcare. And nothing facetious should be covered. Botox injections for wrinkles can be skipped but (something I'm familiar with) Botox injections that I was suggested for my dystonic spasms or for people with Parkinson's should be. The public is to benefit but they should have their say as well.

[Cherie762]

insurance companys often make little sense to me for example mine never covered birth control, it sure covered my two planned pregnancys and then my ooophs pregnancy...my health insurance does not cover mamograms..it would cover breast cancer treatment...precentative medicine is by far the key to cost effectiveness.

However Id really love for liposuction to be covered , its a dream of mine suck out 30 lbs of fat,,,redistribute  a few....LOL  some cosmetic surgery would be awsome never ever believed in it even 10 years ago but gravity is doing strange things,,,,,

[Cherie762]

preventative......I can spell really my mind goes into hyper drive and my fingers dont keep up,