Report on the state of the US Emergency Care System

I'm sure somebody else on SB had to blog this, but just in case it got missed.... the Institute of Medicine of the National Academies released the results of a two-year study that examined the state of the Emergency Care System. The results?

Two words: Breaking point.

This article summarizes the problem. From whence does the problem spring?

At the root of the crisis: Demand for emergency care is surging, even as the capacity for hospitals, ambulance services and other emergency workers to provide it is dropping.

There were almost 114 million emergency room visits in 2003, up from 90 million a decade earlier. Only about half were true medical emergencies. When the poor and uninsured can't get health care anywhere else, they come to emergency rooms, which must treat them regardless of ability to pay.

Serious consequences to be had. For instance:

That in turn means long waits in crowded ERs for hospital rooms to open up. Once stabilized, patients can lie on gurneys in the ER hallway not just for hours but for two days. The new report found that on a typical Monday evening, three-quarters of hospitals reported at least two patients boarded in the halls.

Even getting to the ER is a gamble, the report found, because the EMS system -- emergency medical services that include ambulances, and paramedics -- is so fragmented.

Now imagine a major epidemic such as H5N1 barreling into such a fragile system. This is unacceptable. Something needs to be done.

Links to the three reports can be found here. Educate yourself, and call your representatives. Tell them to address the problem.

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The only way to reduce waiting times is to build more capacity, which inevitably leads to some capacity to idle at times. No one wants to pay for idle capacity. It is similar to the problem we have with our (deregulated) power grid.

It seems obvious, though, that expanding ER capacity owuld be a lot cheaper that the war we're fighting in Iraq, and would bring more benefit, too. So it could be done, it is just that the political will is not there.

Expanding ER capacity isn't the only answer-- making health care more accessible and affordable would be a boon. Perhaps limiting the free treatments ERs are required to give should also be considered, such that they're restricted to things of a more life-threatening nature?

You know hospitals are no longer willing to take losses in their emergency departments, be it from uninsured patients or below-cost reimbursements from Medicaid and Medicare. So they're shutting them down and turning to surgeries such as stomach-stapling, which are far more profitable. I think there should be serious medical reform undertaken to change the situation for the better.