Emerging Emergency
Instead of just owning up to our responsibilities, and demonstrating a touch of compassion for our fellow man, we, as Americans, choose instead to skirt the issue of health care for our nation’s uninsured, and implement half-way measures that give progressive momentum to an already snowballing effect. Now, it’s the turn of U.S. emergency departments (EDs) to shoulder the burden, the debt, and, if unsuccessful, the blame for the lack of primary care afforded to our legions of U.S. citizens, resident aliens, and even “illegals.” We are told that EDs are the only U.S. health care entities federally vested and mandated by law, specifically the Emergency Medical Treatment and Labor Act (EMTALA) of 1986, to screen and stabilize all who seek emergency medical care. Coverage of emergency health services by EDs cannot be denied to anyone in the U.S., and, yet, EDs currently find themselves strapped with an entire series of logistic and financial limitations that render delivery of such coverage tenuous, at best. The over-one million ED visits per year, coupled with hospital closures, in-patient downsizing, the elimination of some EDs by mergers and closures, an aging population, the increasing prevalence of complex medical problems, and the lack of qualified emergency physicians and nurses makes ED crowding the status quo and a quotidian reminder of the failure of the core safety net system, as conceived of and implemented today. If that were not enough, ED crowding is the catalyst for a cascade of subsequent adverse repercussions on ED infrastructure and patient treatment, ranging from compromised quality of care, shorter patient-practitioner interaction, lengthy waiting times, and high stress levels to ambulance diversion, ambulance gridlock, “boarding” (with EDs forced to hold patients for hours), and disaster unpreparedness.
So, with the previously well-oiled gears of the ED machinery nearly grinding to a halt in the current U.S. health care climate, with its greater than 42 million uninsured residents, we are left with the dilemma of what would be required to return EDs to their position of preeminence as vital, and perhaps even cost-effective, elements of the core safety net system. That, however, might be the wrong tack to take, and perhaps the question should be one of whether EDs should play any role at all in primary care of the uninsured and the socially and financially indigent. Perhaps some form of universal health insurance should be mandated to pick up the slack and eventually bear the entire brunt of health care coverage for U.S. citizens and legal residents, whether they be rich, poor, privately or publicly insured, or not. Universal health insurance might be the only truly socially equitable option available, but at what cost to U.S. taxpayers, in what timeframe for implementation, and weighed down with what concessions to the political, industrial, pharmaceutical, social, and other lobbying powers that be?
The so-called experts have been tossing around the idea of universal health insurance for years now, with no luck at consolidating a consensus on what a workable form of such insurance might entail. While no clear trail is currently being blazed, it has become evident that EDs, for their part, are expensive, unable to connect with the community and social resources, and perhaps ill-equipped to deal with chronic management on a large scale. They should not be counted out, however. EDs, or portions of them, might be restructured into 24-h walk-in primary care centers, “social triage” centers, and entry points for later channeling into other branches and components of a community safety network. In that light, they may be “down,” due to their high cost of care, but they are certainly not “out” for the count, and may actually become cost-effective in the framework of a primary care network that would employ them as a triage and starting point that would pass off patients with chronic management issues to a primary care focal point facility, thus alleviating or draining some of the overcrowding inherent in EDs, and contributing “new blood” to a primary health care system in dire need of additional manpower and facilities.
Who knows? With a little well-directed help from EDs, the emerging emergency might even submerge!
So, with the previously well-oiled gears of the ED machinery nearly grinding to a halt in the current U.S. health care climate, with its greater than 42 million uninsured residents, we are left with the dilemma of what would be required to return EDs to their position of preeminence as vital, and perhaps even cost-effective, elements of the core safety net system. That, however, might be the wrong tack to take, and perhaps the question should be one of whether EDs should play any role at all in primary care of the uninsured and the socially and financially indigent. Perhaps some form of universal health insurance should be mandated to pick up the slack and eventually bear the entire brunt of health care coverage for U.S. citizens and legal residents, whether they be rich, poor, privately or publicly insured, or not. Universal health insurance might be the only truly socially equitable option available, but at what cost to U.S. taxpayers, in what timeframe for implementation, and weighed down with what concessions to the political, industrial, pharmaceutical, social, and other lobbying powers that be?
The so-called experts have been tossing around the idea of universal health insurance for years now, with no luck at consolidating a consensus on what a workable form of such insurance might entail. While no clear trail is currently being blazed, it has become evident that EDs, for their part, are expensive, unable to connect with the community and social resources, and perhaps ill-equipped to deal with chronic management on a large scale. They should not be counted out, however. EDs, or portions of them, might be restructured into 24-h walk-in primary care centers, “social triage” centers, and entry points for later channeling into other branches and components of a community safety network. In that light, they may be “down,” due to their high cost of care, but they are certainly not “out” for the count, and may actually become cost-effective in the framework of a primary care network that would employ them as a triage and starting point that would pass off patients with chronic management issues to a primary care focal point facility, thus alleviating or draining some of the overcrowding inherent in EDs, and contributing “new blood” to a primary health care system in dire need of additional manpower and facilities.
Who knows? With a little well-directed help from EDs, the emerging emergency might even submerge!
© 2008, Albert M. Balesh, M.D. All rights reserved.
posted by Dr. Al at
11/08/2008 02:02:00 PM
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