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PaperclipPerfector  9d ago (text post)   30224 thread views

Culture War Roundup for the week of December 9, 2024

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American healthcare is also insidious in that A) emergency care is mandated to to administered, regardless of circumstances and B) if the patient can't pay for their emergency care, then the provider eats the costs.

For SOME reason, Americans can't do the math and realize that this means that paying customers are charged more, and that's why their ER rooms are over-capacity from being used as a universal health service.

To fix healthcare costs, either emergency care is paid for by the state - or emergency care is not administered to those who can't pay.

Sounds like we need a 2 tier emergency room system. An "actual for real" ER for people with medical emergencies and a "you seem to be using this as free healthcare, sit here and we'll get to you in 20 hours" ER. I know they do triage. Some triage strategy would make non-real-emergency people effectively wait forever for an available doctor.

The complicating factor is that many presentations of illness look very similar - does your young person with chest pain have heartburn, an honest to god heart attack b/c of something like genetic disease, anxiety, costochondritis, or something else?

The triage process tries to prioritize people and then once questions are answered (okay the EKG is reassuring, anxious Karen can wait for six hours) readjust how to prioritize people. If you send someone back out to the waiting room and they die because you missed something or had an atypical presentation.....massive lawsuit.

How you get prioritized and triaged usually happens in the background without you knowing about it (for the obvious reasons).

One approach that a lot of places uses kinda zigs a bit from your idea. EDs will have a "fast track" area (will likely have a euphemistic name to make it harder for patients to know) for simpler chief complaints. Work that is expected to be more brainless and less acute (what constitutes this is not necessarily obvious, someone with a diverticulitis flare up or a broken arm is in crippling pain and need some specific intervention but it doesn't require a lot of cognitive resources to figure out the plan) and it's staffed with generally less experienced or competent staff. They can then churn through the simpler cases while people spend an extended period of time in the main idea waiting on labs, images, consults, a hospital bed, someone to figure what the fuck is going on).

You might note the name is kind of the opposite of what you are saying - fast track, so it doesn't disincentivize the over utilization behavior, but ultimately getting people out of beds or the waiting room takes priority, and a lot of regulatory/bonus/compliance structure involves reducing wait times anyway.

My local hospital does have this. I've gone there a few times, all for trauma, and when you go to the triage desk in the emergency waiting room (in the instant case, full of "frequent flyer" senior citizens who are indeed quite ill) with a trauma they immediately send you to a different area (Critical Care).

EMTALA's not getting repealed, so that leaves finding some way to frame publicly paid emergency care as pro-middle class and anti-bum without having too many epicycles.

There's a good discussion on EMTALA today on Meddit:

https://old.reddit.com/r/medicine/comments/1hdpuq6/seeking_advice_on_emtala_violation_allegation/

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