Skip to main content

A new study in the journal Science revealed that emergency room use rose by 40 percent over 18 months among new Medicaid beneficiaries in Oregon starting in 2008. While opponents of Obamacare and its expansion of Medicaid cheered those findings suggesting that U.S. health care costs will go up as a result, their exhilaration may be premature. It's not just that the patterns of health care utilization by newly insured, lower income Americans could still be in flux after so short a period of time. As the Massachusetts experience suggests, after an initial spike ER use slowly dropped over time.

In March 2010, the Wall Street Journal trumpeted "The Failure of Romneycare." A central indictment of the 2006 Massachusetts health care reform that had slashed the ranks of the insured to just two percent while improving health of the newly covered was emergency room use:

The difficulties in getting primary care have led to an increasing number of patients who rely on emergency rooms for basic medical services. Emergency room visits jumped 7% between 2005 and 2007. Officials have determined that half of those added ER visits didn't actually require immediate treatment and could have been dealt with at a doctor's office--if patients could have found one.
But most (though not all) subsequent studies of the Massachusetts overhaul that served as the model for the Affordable Care Act found ER visits declined over time. In her 2012 assessment ("The Effect of Insurance on Emergency Room Visits: An Analysis of the 2006 Massachusetts Health Reform"), Sarah Miller reported an 8 percent decline in emergency department use over a period of several years. Her study followed a 2010 analysis by Jonathan T. Kolstad and Amanda E. Kowalski which found that Mitt Romney's reforms ultimately "affected utilization patterns by decreasing length of stay and the number of inpatient admissions originating from the emergency room." Examining data for hospital admissions originating from the emergency room, Kolstad and Kowalski found "a decline in inpatient admissions originating in the emergency room of 5.2 percent." While ER use by patients in wealthier ZIP codes was essentially unchanged:
We find that the reduction in emergency admissions was particularly pronounced among people from zip codes in the lowest income quartile [with an estimated] 12.2 percent reduction.
That conclusion echoed the findings of a January 2012 study ("Massachusetts Health Reforms: Uninsurance Remains Low, Self-Reported Health Status Improves As State Prepares To Tackle Costs") by Sharon K. Long, Karen Stockley, and Heather Dahlen. They found that a four percent decline in reported ER use between 2006 and 2010.

To be sure, none of the Massachusetts studies offered either the on-point design or the control group of those who did not receive Medicaid benefits that the new Harvard study of Oregon provided. And it's possible that Oregon's experience won't follow the Bay States trajectory. (The Washington Post's Sarah Kliff explains why it probably will.) If that's the case, ER use (roughly 4 percent of U.S. health costs) by the newly insured will increase and not decrease American health care spending. (It should be noted that in Republican states which rejected the Medicaid expansion, hospitals and red state taxpayers will have to foot the tab for uncompensated care by the still uninsured.) If that happens, Americans can take comfort in the studies which show, as the Obama administration rightly claims, "Medicaid saves lives and improves health outcomes."

UPDATE: As the the Post's Sarah Kliff just reported, the Science study only looks at Medicaid expansion over 18 months that began in Oregon in 2008.  But in the years since, Oregon's own Medicaid reforms have started to achieve significant reductions in ER use.

Originally posted to Jon Perr on Fri Jan 03, 2014 at 12:25 PM PST.

Also republished by Daily Kos.

EMAIL TO A FRIEND X
Your Email has been sent.
You must add at least one tag to this diary before publishing it.

Add keywords that describe this diary. Separate multiple keywords with commas.
Tagging tips - Search For Tags - Browse For Tags

?

More Tagging tips:

A tag is a way to search for this diary. If someone is searching for "Barack Obama," is this a diary they'd be trying to find?

Use a person's full name, without any title. Senator Obama may become President Obama, and Michelle Obama might run for office.

If your diary covers an election or elected official, use election tags, which are generally the state abbreviation followed by the office. CA-01 is the first district House seat. CA-Sen covers both senate races. NY-GOV covers the New York governor's race.

Tags do not compound: that is, "education reform" is a completely different tag from "education". A tag like "reform" alone is probably not meaningful.

Consider if one or more of these tags fits your diary: Civil Rights, Community, Congress, Culture, Economy, Education, Elections, Energy, Environment, Health Care, International, Labor, Law, Media, Meta, National Security, Science, Transportation, or White House. If your diary is specific to a state, consider adding the state (California, Texas, etc). Keep in mind, though, that there are many wonderful and important diaries that don't fit in any of these tags. Don't worry if yours doesn't.

You can add a private note to this diary when hotlisting it:
Are you sure you want to remove this diary from your hotlist?
Are you sure you want to remove your recommendation? You can only recommend a diary once, so you will not be able to re-recommend it afterwards.
Rescue this diary, and add a note:
Are you sure you want to remove this diary from Rescue?
Choose where to republish this diary. The diary will be added to the queue for that group. Publish it from the queue to make it appear.

You must be a member of a group to use this feature.

Add a quick update to your diary without changing the diary itself:
Are you sure you want to remove this diary?
(The diary will be removed from the site and returned to your drafts for further editing.)
(The diary will be removed.)
Are you sure you want to save these changes to the published diary?

Comment Preferences

  •  Dollars are a good measure of relative value (11+ / 0-)

    over time, but not of actual value.
    Besides, medical care, like other disutilities, can be expected to see usage decrease as the quality of care (including preventive) improves.  It is because of this inverse relationship that medical care, like fire suppression and even incarceration, is not suited for the market, which relies on increasing custom to maximize profits.

    Obamacare at your fingertips: 1-800-318-2596; TTY: 1-855-889-4325

    by hannah on Fri Jan 03, 2014 at 12:49:28 PM PST

    •  fire suppresion (3+ / 0-)
      Recommended by:
      Elizabeth 44, hannah, CuriousBoston

      This reminds me of people who were under private fire departments, then were surprised that their home burned down because they did not buy a subscription.  If the fire department had been paid by something like taxes or mandatory insurance, the house might not have burned down.  But they chose to live in an area where such things were optional.  I guess for freedom.  The freedom to have the house burn down.

      Conservatives are grasping for whatever straws they can.  It was said that no one would lose insurance, so conservatives whined when a few lost their crappy insurance.  

      It was said that over time emergency room visits would decrease as more people could go to doctors.  So emergency room visits increase, and everyone says yeah, health care reform has failed so let every we don't like continue to die!  But the insurance is not even in effect.  And maybe emergency room visits will increase and maybe that is a good thing.  Now when so kid breaks his leg, maybe it can get repaired with competent doctors.  That would be bad.

      The silliest thing I have head lately is that doctors are going to be more scarce, at least to those on low level plans, and that 'one person' some wingnut knows has to travel 50 miles.  Like this hasn't always been the case.  I know people who routinely travel 150 miles to get medical care.  I am serious.  Because the specialist in the woods have always been crap and they want good medical care.

      Just like other social laws, we are not going to see the effect for a generation or two, and some of it may be surprising.  For instance there is good evidence that the current reduction in crime is related to the removal of lead from gas.  I also believe it is because we are trying to educate everyone, even with a bit of postgraduate work.  I was part of a move to give ample educational opportunities to inner city kids.  I am told my a friend that when he went to school in the post war era, all the minorities would drop out, and his class was basically all white though there were many Hispanics and blacks.  Then there was jim crow and the like During the 70's and 80's the schools became integrated and professional, so by the time 90's came, you had a whole crew of educated people integrated with society that previously would have been criminals.

      We just have to wait.

  •  If you haven't been part of the medical system (17+ / 0-)

    for a while, in many cases the ER may be your first entry point in. But, almost all of those visits will come with the advice to see and/or get a primary care physician for followups.

    The other half of the equation is that those new ER visits aren't necessarily frivolous. (But even experienced and savvy patients aren't always good at guessing what is necessary care and what is not necessary before they get to the doctor.)

    Fry, don't be a hero! It's not covered by our health plan!

    by elfling on Fri Jan 03, 2014 at 12:57:17 PM PST

    •  Excellent point (7+ / 0-)

      and folks just don't know what is available in their communities for alternatives to the ER -- like Urgent Care Facilities (costing much less) and Community Health Centers.  Education about primary care doctors and other facilities at the ER for the next time would be great.

      " My faith in the Constitution is whole; it is complete; it is total." Barbara Jordan, 1974

      by gchaucer2 on Fri Jan 03, 2014 at 01:18:41 PM PST

      [ Parent ]

      •  Rural places may not have urgent care (8+ / 0-)

        Our area has only had an urgent care option since maybe 2010. I believe that what happened was that medical professionals recognized the problem and came together to fix it. I suspect that will happen in other communities also.

        I also had a doctor who addressed it in his own way by having a 7am -8am office hour for walk-in urgent care. Worked very well to keep simple cases out of the ER and to let people who had something come up overnight get in and out and then off to work.

        Fry, don't be a hero! It's not covered by our health plan!

        by elfling on Fri Jan 03, 2014 at 01:33:19 PM PST

        [ Parent ]

        •  A big gap in the US (8+ / 0-)

          healthcare system is the lack of "walk-in" care.  In the UK (and most other countries, I expect) there are usually "surgery hours" open to any patient for emergency or acute symptoms.

          Getting early intervention can be critical even for something as cold symptoms, or stomach pain.  True, Urgent Care facilities are open for this purpose, but an established GP is much better.

          •  Kaiser Permanente (3+ / 0-)
            Recommended by:
            Lencialoo, elfling, CuriousBoston

            has been at the forefront of cost effective quality health care for decades.  Not only have they had Urgent Care Centers for those non-life threatening conditions that usually clog up the ER, but they have had an electronic  system where a patient's drug info/history and health condition follows one from doctor-to-ER-, or Urgent Care visit.  Emailing your doctor for questions, and/or your doctor emailing you has been available, also for some time.  

            Along with that, you can really take charge of your health as you can read your lab results online, and communications online is very accessible.

            Sure, going to your GP is better, but there is always an appt. available for the Kaiser patient.  If your dr. can't see you on a moments notice, everything regarding your health is there for another attending dr. to see.

          •  In our area the walk in traffic is being (0+ / 0-)

            solicited by "little clinics" in grocery and drug stores.

            “The future depends entirely on what each of us does every day.” Gloria Steinem

            by ahumbleopinion on Fri Jan 03, 2014 at 03:04:34 PM PST

            [ Parent ]

        •  Walk-in hour (2+ / 0-)
          Recommended by:
          elfling, CuriousBoston

          Same thing my primary care practice does, walk-ins 8am to 9am daily.  In my case, it's a four doc group and they rotate the morning walk in hour so you probably won't see your own PCP vs one of the other 3, but it's still the same small office with the same nurses, records, etc.  I found it very handy when I had an acute sinus infection.  Usually there's not even much of a wait.  

      •  It would be interesting to compare MA urban (0+ / 0-)

        locations with other parts of the state. Boston has Neighborhood Health Centers that are continually expanded to handle more patients and services.

        These centers are advertised. There are ads to inform people about WIC: the Woman and Childrens progam to make sure pregnant females and infants get proper nutrition and referrals.

        Anecdote. I know of two people that used ER rooms until a social worker sat one down, explained how appointments at a community center could be scheduled not to interfere with his work hours. The other persons employer was told that the employee should be allowed to go to medical appointments, if not, sir, I'll make sure you look so bad.

        Many people are afraid to lose their jobs. If they have multiple jobs, it is worse. Transportation is a huge issue.

        As more people see and teach others what resources are available, ER visits may go down.

        Help Senator Warren. Encourage people to co-sponsor her bills, & the bills she has cosponsored. Elect Ed Markey.

        by CuriousBoston on Sat Jan 04, 2014 at 09:33:23 AM PST

        [ Parent ]

    •  The rise in urgent care outpatient facilities (5+ / 0-)

      Will take a lot of the pressure off the er.

      They didn't exist in the numbers they do now when that survey was taken. I know we have at least 5 doc in a box type facilities here, and a few years ago we had one, if that. They don't require an appointment and can refer you to a primary care doc or specialist.

      If you don't have a primary doc, chances are that's where you'll go unless it's really a middle of the night scary thing.

    •  Triage Nurse First? (0+ / 0-)

      I've been to the ER once in my 72 years on earth: that to take my wife to the hospital for fever, abdominal pain, etc. She was admitted to the hospital with gallstones. Very painful and not frivolous.

      But the first thing that happened after entering the door to the ER was a visit to a triage nurse, this within 5-10 minutes of entry. Vital signs taken and referred to an MD who sent my wife off on a gurney.

      I don't see how you can improve on the efficiency of that nor that it was terribly expensive, off hours and weekend, true.

      Anyone who drags a kid in with a flushed face and a runny nose ought to pay more for bothering the hospital IMO. I fail to see why frivolous visits would happen more for new Medicaid people than with anyone else.

      What stronger breast-plate than a heart untainted! Thrice is he arm'd, that hath his quarrel just; And he but naked, though lock'd up in steel, Whose conscience with injustice is corrupted. Henry VI Part II Act 3 Scene 2

      by TerryDarc on Fri Jan 03, 2014 at 03:21:03 PM PST

      [ Parent ]

  •  The unaddressed question: (14+ / 0-)

    What alternatives to the ER exist in the community, and how widely advertised are they? Urgent care centers and community health clinics are two that come to mind. Do they exist, and do people know that they exist?

    Or if you've never had insurance, are you just accustomed to going to the hospital ER, because they have to treat you there, so you don't think about other options? And you're not used to calling the 800# on the back of your card, where they will try to steer you to cheaper alternatives for non-life-threatening illnesses or injuries.

    Or (as I found in my only ER visit in the past 20 years), are the other alternatives only open M-F 9-5, and you need care evenings or weekends?

    My hope is that as the number of uninsured people goes down, it will be economic for clinics to do more advertising, and to stay open longer hours -- the good kind of competition -- and people will learn that they have options other than the ER.

    •  I should have read (7+ / 0-)

      your comment prior to posting my redundant one under elfing's comment.

      For instance, I had no clue that there was an urgent care facility right up the road from me.  I just received my insurance card yesterday so was uninsured for a serious cat bite, years ago.  Went to the ER -- second cat bite I looked up alternatives and there was the urgent care number.  The physicians asst. said they probably would have sent me to the ER for the first bite since I had to have an antibiotic drip for two days.

      When I received my card I also received copious info regarding having to find a primary care doctor, how to find one either online or by phone.  

      " My faith in the Constitution is whole; it is complete; it is total." Barbara Jordan, 1974

      by gchaucer2 on Fri Jan 03, 2014 at 01:23:09 PM PST

      [ Parent ]

    •  people are, let's face it, creatures of habit (1+ / 0-)
      Recommended by:
      tofumagoo

      I suspect that ER visits WILL go up...

      What remains to be seen, and it will probably take until this time a year from now...how all of this shakes out.

      My hope is that the ACA doesn't result in an unexpected increase in health care costs, but my pessimistic nature is such that I can't help thinking it will, after all of the dust settles.

      If that happens, it will be interesting to see how everyone here spins it.  First of all...there is no doubt a pent up demand for medical care from those who could not previously afford it.  How long it takes to clear that backlog is anyone's guess.

      Americans aren't used to getting something without paying through the nose for it.  I hope there isn't a "rush to the smorgasbord" effect, and a resulting spike in costs.

      I haven't signed up yet.  I still have time, and I'm a procrastinator.  I have a tentative job offer that I will know for certain about in two weeks, that would include employer provided health care...so I am still weighing my options.

      I haven't seen a doctor in 8 years, and have a chronic knee condition that I have simply sucked up the pain on, as well as a disturbing, itchy mole in one sideburn that may be skin cancer or may be nothing.  I probably need my prostate looked at, as well.

      I suspect there is a veritable logjam of unattended health issues out there among people like me.  We can all celebrate the healthy enrollment figures of the past few weeks...but if the next 6 months see a deluge of people going to see the doctor, it is going to look like the lid has been lifted from Pandora's Box.

      L'enfer, c'est les autres....Jean-Paul Sartre

      by Keith930 on Fri Jan 03, 2014 at 03:44:52 PM PST

      [ Parent ]

  •  Discharge planning and follow-up helps (6+ / 0-)

    Research studies have shown an impact of discharge planning and follow-up for ER patients. For example, this study published in 2003 reported a drop in ER usage and cost savings using a community health worker outreach program for patients with diabetes and repeat admissions to ER. ER visits declined 40%, with annual savings per patient of $2245 (back in 2000 or so.)

    Another study published in 2013 noted that emergency departments can play a key role in referring people who need outpatient special care. For patients in Medicaid and other public programs, referrals may be difficult even if they have primary care docs or go to an outpatient clinic; this study suggests that care coordination can help even if the mechanism is through the ER. That might account for some of the increase and then eventual reduction seen in MA: high-risk patients getting referred through the ER to better outpatient care, which their insurance will now cover.

  •  that's nice (0+ / 0-)

    but the cost for insurance has gone up each year. We saved money for hospitals and insurance companies but not for the consumer.

    I sing praises in the church of nonsense, but in my heart I'm still an atheist, demanding sense of all things.

    by jbou on Fri Jan 03, 2014 at 02:15:06 PM PST

    •  And now it will GO UP LESS OR DROP (rebates un (2+ / 0-)
      Recommended by:
      Tonedevil, CuriousBoston

      der 80% rule added).  I don't know what planet you're living on, but private ins. pre-ACA premiuns went up over 10% a year and usually much more.  Heck, I saw a 34% increase one year and a 20-something the next year on Blue Cross.  Did health care costs rise 50% in 2 years?  No the frakking did not.  That $ went directly into rich folk's pockets at expense of middle class.

      Even if premiuns post-ACA go up @ half the rate - and data indicates whatever increases will be far less - its still a BIG WIN for everyone who was being gouged year-after-year or forced to drop ins. pre-ACA.

      •  so what is stopping them from raising rates now? (0+ / 0-)

        I sing praises in the church of nonsense, but in my heart I'm still an atheist, demanding sense of all things.

        by jbou on Fri Jan 03, 2014 at 03:56:58 PM PST

        [ Parent ]

        •  For one thing, the 80% rule that Chris mentioned (3+ / 0-)
          Recommended by:
          Tonedevil, CuriousBoston, chrismorgan

          means that your insurance company has to spend at least 80% (85% under certain circumstances) of your premiums on actual health care. If they don't spend at least 80% of your premium on care and quality, you will get a check in the mail with a rebate. That regulation will reduce some of the incentives for raising rates, because if they're raising rates to pay more in administrative costs, overhead, and ads they're just going to end up giving a lot of that money back through rebates. That's not going to completely eliminate the problem of rising health care costs, but it will help.

          •  so that's it? (0+ / 0-)

            that's laughable. How the fuck will we know what they are spending on our healthcare vs what they collect for premiums?

            I sing praises in the church of nonsense, but in my heart I'm still an atheist, demanding sense of all things.

            by jbou on Fri Jan 03, 2014 at 06:20:45 PM PST

            [ Parent ]

            •  You think they don't keep records? (1+ / 0-)
              Recommended by:
              Tonedevil
              •  I have a bridge to sell you in Brooklyn (0+ / 0-)

                I sing praises in the church of nonsense, but in my heart I'm still an atheist, demanding sense of all things.

                by jbou on Fri Jan 03, 2014 at 06:31:18 PM PST

                [ Parent ]

                •  See, you're attempts to insult me (2+ / 0-)
                  Recommended by:
                  CuriousBoston, chrismorgan

                  don't make you sound right.

                  The insurance companies have to report how much they take in from premiums, how much they spend on health care and quality and how much they spend on other things. They need to keep documentation for all of those things, and they need to make it available to HHS so that it can be verified. Failure to comply with the 80/20 rebate rule results in fines.

                  •  yup (0+ / 0-)

                    but our regulatory agencies are understaffed and can be influenced by the industries they are supposed to regulate. So you'll forgive me if I have some doubts. The evidence is overwhelming that our regulatory agencies have become pretty freaking inept.

                    I sing praises in the church of nonsense, but in my heart I'm still an atheist, demanding sense of all things.

                    by jbou on Fri Jan 03, 2014 at 07:15:32 PM PST

                    [ Parent ]

                    •  Regulatory agencies aren't perfect (1+ / 0-)
                      Recommended by:
                      CuriousBoston

                      but before this law went into place the insurance companies could raise your premiums for whatever reasons they saw fit and routinely had very high overhead costs. It won't take 100% compliance to save consumers money. Doubt is fine, but we've got to keep in mind where we started from when thinking about this law (or any law, for that matter).

                      For what it's worth, there are other cost-cutting measures involved. From the premium standpoint, companies will now have to get approval to raise premiums by more than 10%. Covering more preventative care, which is now required of all insurance plans, is also expected to lower long term costs by reducing more expensive health problems down the road (basically trying to reduce the "penny wise, pound foolish" mentality). Those savings won't kick in right away. There are other things as well. It's by no means a perfect law, and honestly I would have preferred larger changes, but it's much better than what we had before.

                      •  I get it (0+ / 0-)

                        this is the shit we have to deal with and it is shit. until we eliminate the profit motive from health care we are not going to even come close to having an adequate system.

                        I sing praises in the church of nonsense, but in my heart I'm still an atheist, demanding sense of all things.

                        by jbou on Fri Jan 03, 2014 at 09:13:34 PM PST

                        [ Parent ]

                        •  I'm with you there. I'd prefer single payer myself (1+ / 0-)
                          Recommended by:
                          CuriousBoston
                          •  U are also ignoring side-by-side competition the e (0+ / 0-)

                            xchange mandates.  Kinda suicide to jack your rates when consumers can see others didn't and simply switch to them (bc all plans are mandated pretty much similar on everything but networks).  Also remember, rates only go up once a year, when policies in the individual markets come up for renewal by their own terms.

                            BTW, I too favor single-payer - specifically Medicare buy-in as that also strengthens that program, politically and financially - but that doesn't mean I am not able to see that there are also benefits in the ACA approach, as well as costs.  (But then there are also costs to the single-payer model, e.g., no more health ins. companies.  But I don't really care that bazillionaries wont be able to make money by gaming the deaths of less wealthy.:))

                          •  There are definitely benefits in the ACA (0+ / 0-)

                            approach. It's certainly better than what we had before. I think single-payer would be better, but I also recognize that that's not a politically feasible option right now. The ACA was a big step in the right direction, and there are a ton of ways that the law tries to lower costs.

                            I wasn't really ignoring the exchanges, as the conversation I was having focused mainly on the 80/20 aspect of the law and how that will work. I agree with you about how those side-by-side comparisons will benefit consumers and cause companies to lower their prices (or at least keep them in line with one another). I do wish we had been able to include a public option in the exchanges, though, and I think that would have driven the for-profits to lower costs even more. But again, the ACA is a significant improvement over what we had before, and it's a major accomplishment.

                          •  Srry my comment really was directed to jbou's (0+ / 0-)

                            not yours.  I pretty much agree with all your above comment.  It pisses me to no end that the reason we don't have Medicare buy-in is bc Lie-berman threatened to filibuster it... and it was his own idea.

  •  some excellent links to read (8+ / 0-)

    if you are interested (I will post some in tomorrow's APR):

    A few thoughts on the latest Oregon Medicaid results (A Frakt)

    The latest results from Oregon aren’t actually very counterintuitive (A McIntyre)

    Medicaid – and what having it means to ERs (Harold Pollack)

    and see

    I think people are losing sight of the fact we're talking about 0.4 extra visits a year. http://t.co/...
    @chrislhayes
    @chrislhayes Actually 0.4 visits/18 months, I believe. $120/yr is maybe 3% of Medicaid costs for these individuals.
    @haroldpollack

    "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

    by Greg Dworkin on Fri Jan 03, 2014 at 02:19:52 PM PST

  •  Patience and perseverance is needed (7+ / 0-)

    and that is not a strong point for Americans.  The key here is "over time,"  Obamacare will find its leveling point.  The negatives will fade, and the positives will be at the forefront where they belong.This hasn't happened on January 1, 2014, nor will it, most probably on January 1, 2015.  The delivery system for this huge undertaking will take at least a decade.  

    Revamping our health insurance delivery system, something that has NEVER been done before in this country is going to take time, fixes, adjustments, and 10 years from now probably won't look the same as it is today.

    The main purpose of Obamacare is really a Patient Protection Consumer regulatory system that stops your insurance carrier from screwing the policyholder over.

    With your premium you can now be assured that you can't be purged from the rolls if you get too sick, you can't be denied insurance if you have a preexisting condition, the lifetime cap has been lifted, a young adult can remain on their parent's plan until age 26, 80% of your premium must now go to your medical care, and standards are now in place where the whole person must be covered, male/female, including mental health, etc etc.

    There are forces that want to weaken this law, it is imperative that as more people realize the lives saved, the costs reduced, and the long vision in view, we stand together and don't let these malcontents stop progress.

  •  Where is the snark tag? (0+ / 0-)

    Right here is the reason for the drop in visits to the Emergency Room-

    http://www.commondreams.org/...

    "The people who were trying to make this world worse are not taking the day off. Why should I?”---Bob Marley

    by lyvwyr101 on Fri Jan 03, 2014 at 02:55:54 PM PST

  •  Thanks for posting this (5+ / 0-)

    I've been very annoyed by the moronic way this new "study" has been received.  Individuals and communities need co-ordinated care and they don't get it. Lots of people don't have a regular doctor and end up going to the ER to get advice/get seen or because they think they are having an emergency. You can't always tell what is happening.

    I am in MA and have a good primary doctor and come from one of those upper income zip codes. A few years ago now my husband had massive, crushing, back pain that put him on the floor for six hours.  In consultation with his doctor I took him in an ambulance to the ER--why? Because your doctor doesn't have permission to directly admit a patient into the hospital for one of these emergency things and the ER has the right to jump the que for all tests so the fastest way to find out what was wrong, get all tests, and get my husband a bed was to go through the ER.  

    This ended up happening twice within 24 hours because the ER released my husband prematurely and we were back again within 24 hours.

    My point here, and I do have one, is that even with "walk in care" and a primary care doctor you may end up in the ER--be you as savvy a health care consumer as you want to be.  And the follow on care from the ER is abysmal. In our case we had our primary care doctor but if we had walked in without one the hospital would not have been able to set us up with one. A new medicaid patient who does not have a doctor or a local clinic needs help navigating the system. There should be social workers who walk them through the process and get them hooked up with a good doctor in their area and make sure they get seen.

    •  My daughter lives in MA and b4 romneycare... (2+ / 0-)
      Recommended by:
      JamieG from Md, CuriousBoston

      lot's of friends had no insurance/primary doc and would go to ER for a hiccup. Now they go to the their doc or to an urgent care joint as they have health insurance (tnx to romneycare).

      But she said going to the ER is a tough habit to break and it took years for several of them to get with the program.

      Romneycare, as the diary graphs show has been a great benefit to Massachusetts citoyens. Obamacare will be the same for our country. It started in Massachusetts like our war of independence. Thank you Governor Romney (even though he hates to hear someone say it).

    •  I had an elderly neighbor who when she couldn't (0+ / 0-)

      walk one morning, had me call her doctor.

      Who said, "Get her to the Emergency Room."

      She was on Medicare, of course.

      So...with the ACA, maybe even more access to ER, since your doctor would send you there, in an Emergency.

  •  Its called 'pent up demand' and every econ I stude (3+ / 0-)

    nt knows about it.  They also know the spike is, by definition, temporary.

  •  A person who comes into ER with an illness, (0+ / 0-)

    infection, or injury that has gone from not so bad to quite serious is fairly likely to end up back in ER again with complications caused by the delayed treatment.

    A person who comes into ER or a limp in clinic (I love and use minimal care clinics they are great for early care of a minor illness or injuries) with a non serious illness, injury or infection is far more likely to be successfully treated and cured by one visit.

    That's just common sense.

    I agree with comments above, local easily accessed minimal care 24/7 clinics are great.  So is a GP but they aren't open 24/7.

  •  Taking comfort (2+ / 0-)
    Recommended by:
    CuriousBoston, nextstep

    "Americans can take comfort in the studies which show, as the Obama administration rightly claims, "Medicaid saves lives and improves health outcomes.""

    Unless of course, as also found in the Oregon study, that the lottery group that got Medicaid didn't exhibit notably better health outcomes.
    http://www.hcp.med.harvard.edu/...

Subscribe or Donate to support Daily Kos.

Click here for the mobile view of the site