
Nearly half of US medical visits are at emergency rooms - marojejian
https://www.sciencedaily.com/releases/2017/10/171017091849.htm
======
mysterypie
The summary and headline are badly misleading. It sounds like shocking news,
but what they really found is disappointing but not that surprising.

It's not half of US medical visits to _any kind of medical care_ that are at
emergency rooms. It is half of US medical visits to _hospitals_ that are at
emergency rooms.

That's a big difference. Among other things, they are not including visits to
your family physician. If they included ordinary visits to your doctor outside
of the hospital, then emergency rooms visits would be a much lower percentage.

Looking at the original abstract:

[http://journals.sagepub.com/doi/10.1177/0020731417734498](http://journals.sagepub.com/doi/10.1177/0020731417734498)

It says, "Our study aimed to determine the contribution of EDs to the health
care received by Americans between 1996 and 2010 _and to compare it with_ the
contribution of outpatient and inpatient services using National Ambulatory
Medical Care Survey and National Hospital Discharge Survey databases."

They are comparing emergency visits to other kinds of hospital visits.

~~~
payne92
Bingo, I’m so glad you clarified this. Something “didn’t smell right“ here.

Even beyond the family physician, there are many specialists that are
affiliated with hospitals but see patients in their offices, outside of the
hospital registration process.

In fact, those specialists often have offices in the hospital or in buildings
attached to the hospital.

------
Mrtierne
Just another report highlighting the need for change to our current healthcare
system.

Although anecdotal, multiple family members who are health care providers in
the ER (Nurse, PA, Doctor) it's more often than not far from an emergency
ailment. This creates a scary supply and demand scenario.

~~~
gricardo99
Yup. The system is pretty messed-up and from my view (as a user), it drives
people towards ERs as there are few other options. Some examples:

1 - Any time a condition/illness causes bad nausea/vomiting, the urgent care
will send you to an ER to get IV meds and fluids, which they can't do. You
probably don't need a full ER, but that's the only place to go. This must be
fairly common during flu season, and a huge waste of resources. A startup idea
could be an Uber for off-hour home visits. If all you need is IV fluids, check
some vitals, keep you comfortable to ride-out a nasty virus, surely it's in
everyone's interest to have a quick visit by a nurse/PA, possibly MD.

2 - Pain management. If you have a relatively new illness or injury that
requires stronger medications to manage the pain, you have no choice but to go
to an ER, or perhaps be admitted to a hospital (which is even more expensive).
I can't say if over a longer period of time, for a chronic case, there are
better options that eventually get worked out. But 2 months into such an issue
with a family member, and going to the ER was frustratingly the only option.

3 - Chest pain. Yes, it could be a heart attack, so maybe an ER is the best
place to go. You will get triage pretty quickly with an EKG, and some basic
vitals, but you're still stuck there for hours if it's a false alarm (I'm
guessing quite often). There's got to be a better way.

~~~
halfteatree
3 has been an issue for me recently. I was referred to ER for some chest
discomfort, which, unfortunately, the school clinic I was studying at cannot
do the blood tests to see if it's a blood clot. I was given scary words like
"you could die from this if untreated".

For that reason, I visited ER twice that week, and was diagnosed with some
mild stomach issue and stress. Every single test they ran gave negative
result. It's a huge waste of time for me, and I feel very guilty for wasting
ER resources (especially as an immigrant). There has got to be a better way.

Edit: I was very lucky to be covered under school-mandated health insurance,
and I don't think you could live comfortably in the U.S. without having one.

------
exhilaration
Urgent Care facilities and walk-in clinics can fill the need for immediate,
after-hours care at a far lower cost than the ER. Here's a screenshot from my
health insurance provider, you can see it gives options along with a
comparison of their cost:
[https://imgur.com/a/4Lqb7](https://imgur.com/a/4Lqb7)

~~~
fillskills
There is a major lack of information and advertising around Urgent Care. Very
very few people know Urgent care exists. And in what form does it exist. Its
different across states and cities.

Comparatively, Emergency care/Ambulances are available almost everywhere
through 911 AND take most of the mind space around urgent issues.

Finally, Urgent Care centers are not equipped to handle lots of things like
broken bones etc. They just refer you to an emergency center instead.

~~~
AnthonyMouse
> There is a major lack of information and advertising around Urgent Care.

Maybe we should just put the Urgent Care facility in the same building as the
ER and then route people appropriately when they show up.

------
excalibur
This isn't that surprising. The cost of health care is so astronomical that
many people WITH insurance refuse to go to a doctor until their condition is
so bad they can't avoid it any longer, and then it's straight to the ER.

~~~
jackmott
yeah having insurance, even for some of us with six figure jobs is "we give
you a small tax break on the first 10,000 you spend on health care every year
in exchange for paying us $300 a month!"

thanks?

------
trhway
just a personal anecdote (i don't think that such situation affects any
significant percentage of people though) - English words "urgent" and
"emergency" translates to basically the same Russian word which means
"emergency". Given that "urgent care" is missing in Russian medical system (at
least 20 years back it was), we, being recent arrivals and thus not very
skilled in both, English language and the details of US medical system, were
going to "emergency" whenever told to go to "urgent care", and we were so
disappointed that regular US doctors would refuse to see us except by
appointment of some weeks/month in the future when an issue would require
prompt attention, and they would be sending us to "emergency" instead (as it
sounded to us when in reality it was urgent care). We thought that it is such
an inefficient system - either appointment in 2 months or emergency room
(where we'd wait 3-4 hours - obviously our issues weren't any close to
priority there, and where we obviously wouldn't get a specialist attention
which would better suit the issue we came with). Sometime later (after 6 years
in US :) we did accidentally learn about urgent care.

------
trendia
Strangely, a study on whether providing expanded medicaid* would reduce
emergency room visits seemed to suggest that it did not:

> It was widely believed that having insurance would encourage people to get
> routine medical care in doctors' offices or clinics, instead of waiting
> until they have more serious symptoms and have to head to the ER, where care
> is most expensive.

> The study's first findings, published a few years ago, showed that Medicaid
> was beneficial in many ways. It improved people's financial security. They
> went to the doctor when they were sick. And having the insurance correlated
> with a drop in rates of depression.

> But the study also found Medicaid enrollees increased their emergency room
> visits by 40 percent over the first 15 months.

[0] [http://www.npr.org/sections/health-
shots/2016/10/19/49852611...](http://www.npr.org/sections/health-
shots/2016/10/19/498526110/emergency-room-use-stays-high-in-oregon-medicaid-
study)

edit: fixed medicare / medicaid

~~~
HarryHirsch
_But the study also found Medicaid enrollees increased their emergency room
visits by 40 percent over the first 15 months._

Well, did they go there because they were actually ill? If so, the experiment
did in fact improve public health.

~~~
trendia
From another article on the same study (albeit earlier):

> "Medicaid coverage increases emergency department use, both overall and for
> a broad range of types of visits, conditions, and subpopulations," says Amy
> Finkelstein, an economics professor at MIT and one of the authors of the
> study.

> "Including visits for conditions that may be most readily treatable in
> primary care settings."

[0] [http://www.npr.org/sections/health-
shots/2014/01/02/25912808...](http://www.npr.org/sections/health-
shots/2014/01/02/259128081/medicaid-expansion-boosted-emergency-room-visits-
in-oregon)

~~~
HarryHirsch
_" Including visits for conditions that may be most readily treatable in
primary care settings."_

That's just engrained practice. People used to go to the ER instead of a
regular physician, now they continue what they always did. You ask yourself
why the hospital doesn't set up a regular practice on the premises and has
triage send patients there.

~~~
vonmoltke
> You ask yourself why the hospital doesn't set up a regular practice on the
> premises and has triage send patients there.

In Texas, they are legally prohibited from doing so. They would have to send
you to a physically-separate location, even if said location was still in the
hospital's parent network.

------
PaulHoule
What I can't get is that my primary care doc makes me wait 6 weeks to get a
checkup.

It seems like it doesn't take any more resources to take care of me next week
then it does 6 weeks later.

~~~
trendia
The reason you have to wait 6 weeks is that the doctor's office does not have
infinite capacity, and increasing that capacity would require adding nurses,
doctors, and rooms.

Instead, the 6 weeks is a result of 1) the number of people who wish to get
appointments, 2) the time that each person spends, and 3) the number of people
who can be treated at a time:

MeanResponseTime = MeanNumberInSystem / MeanThroughput

[0]
[https://en.wikipedia.org/wiki/Little%27s_law#Finding_respons...](https://en.wikipedia.org/wiki/Little%27s_law#Finding_response_time)

~~~
nradov
That doesn't really work for medical offices. A better solution is to reserve
more schedule slots each day for patients who call or just show up that day.
That makes the overall system more efficient since patients with urgent
symptoms don't have to go to urgent care or ER.

~~~
trendia
Urgent Care clinics might help fill the gap between long term care (where
delays are OK) and emergencies (where delays are not OK).

~~~
nradov
Urgent care is still more expensive than visiting your regular doctor. And
it's less effective because the urgent care doctors are less familiar with you
as a patient, so it takes longer to get up to speed on current symptoms and
the risk of error is higher.

------
fishcolorbrick
Here's a nice graph[0] showing the relationship between income inequality and
healthcare, and a good quote:

"The high-income group, with average household income greater than $70,000, is
the standard to which all others are compared... 30 percent of the population
in the $30,001–$50,000 range ...have 59 percent more mortality than is true of
the richest group."

[0]:
[http://content.healthaffairs.org/content/21/2/31/F2.expansio...](http://content.healthaffairs.org/content/21/2/31/F2.expansion.html)

Source:
[http://content.healthaffairs.org/content/21/2/31.full](http://content.healthaffairs.org/content/21/2/31.full)

------
rdtsc
Even with insurance, they implicitly encourage people to say everything is an
"emergency" because otherwise you'd have to call them to get approval. But if
you say "it was an emergency" you can avoid having to jump through hoops. So
you go, and it clogs the emergency room, everyone pays more.

------
0xbear
The disappointing part of the US medical system is it doesn’t do much for you
unless you’re really seriously ill or about to die. If you’re about to die,
it’s the best in the world. If you just eg have a shoulder pain or something —
you will have great difficulty finding a competent doctor to deal with it.
People discover this by their mid to late 30s, around the time they begin to
have their first real health problems.

------
mikestew
Well, what does one expect when the answer given by many when the topic of
socialized medicine comes is "go to the emergency room, they can't turn you
away for having no money"?

~~~
fav_collector
Especially when it covers non-citizens and people who are illegally in the
country.

We could at least have a little compromise by making health care more tiered
so that citizens, payers and people with insurance receive better health care
than others. Make a list of services that will only be provided to payers and
automatically push non-payers to the back of the queue.

~~~
nck4222
I would view that as a horrible compromise, because it would result in poor
people receiving worse health care than wealthy people.

~~~
throwaway5752
I'm amazed sometimes the things people say here. The idea of withholding
medical care based on citizenship comes very close the criteria for evil, with
the drawback that it's largely incorrect, too (non-citizen residents, legal
and illegal pay taxes at many levels of government for far less in return
comparably than citizens).

~~~
ythn
What is the maximum amount we should spend to save a human? A million? A
billion? Should society absorb any cost to save a human even if it gets
exponentially more expensive with each subsequent procedure? Or should there
be a cutoff where you are basically told "Sorry, you've exceeded the threshold
and have to either pay for it yourself or die"

~~~
dv_dt
It would seem that the cost of being stingy here is that the medical care
system is _more_ expensive for less performance in the US. Cut off your nose
to spite your face exemplified.

------
wnevets
Didn't one of the anti-obamacare republicans say this is how most americans
should get their medical care?

------
gsnedders
How does this compare with elsewhere?

------
alexanderstears
Stop letting the elderly and poor use E.R rooms as convenient one stop shops
and it'll sort itself out.

~~~
knz
Do you have an alternative proposal for how these people access health care
services?

[https://data.oecd.org/healthres/health-
spending.htm](https://data.oecd.org/healthres/health-spending.htm) implies
that the US is spending considerably more (~ double the OECD average) per
capita. ER visits could certainly explain some of that.

~~~
alexanderstears
[https://market-ticker.org/akcs-www?post=231949](https://market-
ticker.org/akcs-www?post=231949)

The crux is making it easier for consumers to get health care information,
putting more choices in the hands of the patient, and creating a mechanism to
encourage price sensitivity even if people don't pay for their care directly.

~~~
knz
Respectfully, I feel this link is missing the broader picture - that the US
has a health care system unlike any other OECD nation. Perhaps the crux is
looking at models that have been successful in other countries and adapting
them to the US?

~~~
alexanderstears
America should lead the world in healthcare and many of those proposals would
help us accomplish as much.

We're mired in this current system with no rationing, low accountability, and
rentiers sucking cash with the Government's approval and leftist protection
against any reduction to the cashflow. Look at the yelps ushered by leftists
when Trump stopped giving insurers free money - many of them bemoaned the loss
of corporate welfare.

