
As ER Wait Times Grow, More Patients Leave Against Medical Advice - Vaslo
https://khn.org/news/as-er-wait-times-grow-more-patients-leave-against-medical-advice/
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pjc50
> Moreover, ER wait times also increased for many during that time period: In
> 2017, the median ER wait time for patients before admission as inpatients to
> California hospitals was 336 minutes — or more than 5½ hours

Comparable stats from the UK: [https://www.kingsfund.org.uk/projects/urgent-
emergency-care/...](https://www.kingsfund.org.uk/projects/urgent-emergency-
care/urgent-and-emergency-care-mythbusters)

> By September 2017, the median waiting time had increased to 2 hours 28
> minutes, and 95 per cent of patients departed A&E within 7 hours of arrival.

So not only do Americans get to wait twice as long, but they have to pay for
it as well? You have to pay for _ambulances_? Why is this not politicized
more?

Mind you, where ever you go and however the system is run, queues will be
worse in the evening especially at weekends. Some queueing is unavoidable and
best dealt with by triage.

~~~
AnthonyMouse
> So not only do Americans get to wait twice as long, but they have to pay for
> it as well? You have to pay for _ambulances_? Why is this not politicized
> more?

Emergency services are run by the cities, or sometimes the states. And that's
a completely reasonable thing to do -- if you have a heart attack in Los
Angeles, they don't take you to an emergency room in Boston. Local people
should control local stuff.

So you're asking the wrong question. It's not a matter of what happens in
America, it's a matter of what happens in California, or Los Angeles. Other US
cities have free ambulance service or shorter wait times.

The local people can change their local laws whenever they like.

~~~
ppseafield
By your same argument, if a state is running the emergency services, what
guarantee is there e.g. a heart attack in Los Angeles doesn't end up in
Redding?

It would be possible to have emergency services organized nationally. I wonder
if cities that overlap two or more states share emergency services. Seems like
that would be ideal so that you'd always end up in the closest hospital.

~~~
AnthonyMouse
> By your same argument, if a state is running the emergency services, what
> guarantee is there e.g. a heart attack in Los Angeles doesn't end up in
> Redding?

Well for one thing, because it's more than 500 miles away.

> I wonder if cities that overlap two or more states share emergency services.
> Seems like that would be ideal so that you'd always end up in the closest
> hospital.

Of course. It's the same as people who visit another state can still use the
roads in that state. It's easier to cover a non-majority percentage of usage
from out of state residents in exchange for implied reciprocity than to do a
bunch of two-way accounting that in practice will generally just net to zero
anyway.

The services are organized and funded locally because the local people are the
ones with the strongest interest in them. Most of the people who use emergency
services in Los Angeles will be people from Los Angeles, so they're the ones
with the greatest interest in whether they're implemented competently and
efficiently.

The problem with nationalizing things like this is that they have no real
economies of scale, so all you're doing is adding unnecessary bureaucracy and
creating wasteful arbitrage opportunities. Because then it's in the interest
of the majority of states who pay less in taxes than they receive in benefits
to inflate costs on purpose because it brings federal money into their state.
California and New York -- and Texas -- have been getting screwed by this for
years across a wide variety of federal programs that don't actually need to be
_federal_ programs.

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code_duck
I had a serious complication of a medical problem a few years ago. After being
bedridden and unable to lie flat for over 3 weeks, I developed a pilonidal
cyst. This is a small abscess, usually from an ingrown hair, that expands into
a cavity at the very base of your spine. I was in severe pain, had a visual
lesion, and was almost unable to walk.

I went to an urgent care clinic. The friendly staff told me they did not take
my insurance, but could do it immediately for $380 in cash. As I was hoping to
find someone who took my insurance, I declined. I went across the street to
the emergency room. The person at check-in heard "pain" and "back" and seemed
to immediately decide I was a drug addict. 30 minutes later I talked to some
decent check-in staff who told me they would give me surgery for it.

I ended up waiting in the ER for over 3 hours. When they finally did the
surgery, it took about 10 minutes. Somehow, they messed up the billing. The
charges were over $1,200 for the 10-minute surgery that the Urgent Care
offered to do for $380. After moving out of state, I called multiple times to
get them to properly charge my insurance. They failed to do so, and sent the
entire bill to collections 90 days later.

~~~
takeda
If it is what I think it is, it I'd not a surgery but a simple procedure to
drain it. It took about 10 minutes and they were able to do it in urgent care
for me so it cost me just the copay for the visit - $35. I wrote in another
comment that people don't know that they can use urgent care most of the time.
I forgot about the issue you had, which is insurance. That's also a huge
problem that you can only use certain facilities. I remember being stressed
about it when a family member was in pain. The thing is that once I found one
that works with my insurance and is 24/7 I already know where to go so I
forgot about that hassle.

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gre
My friend knifed his baby's finger open at a backyard bbq in Mountain View and
we had to wait six hours for a couple of stitches in Palo Alto on a Sunday
evening starting at 9pm. Extrapolate that wait time to poorer areas, to people
who don't have health insurance, to people who have other obligations...

~~~
liveoneggs
an "urgent care" can also do stitches for injuries like this

~~~
riku_iki
Urgent care is closed at 9pm Sunday at least in MTV.

~~~
liveoneggs
everything in MTV is closed after 9pm, any day of the week :)

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afarrell
In the UK, there is a phone service you can reach by dialing 111. There, a
nurse can listen to you describe your issue and advise you if you need to go
to hospital, make a next-day appointment with your GP, go to se the local
pharmacist, or just get bedrest. My wife and I have used this a couple times
and its great. It is something that I’d love to see brought to the US.

One aspect of the service that gives us a lot of piece of mind is that they
can confidently and immediately tell you how much the NHS would charge you for
their recommended course of action. I do wonder how you would build a similar
system that could tell you what your medical insurance would cover and what
your copay would be.

~~~
AnIdiotOnTheNet
> I do wonder how you would build a similar system that could tell you what
> your medical insurance would cover and what your copay would be.

This is literally impossible, by design, under the current system in the US.
Neither the provider nor the insurer is able to tell you what something costs
until they've had a few rounds at the dartboard to determine that.

~~~
Godel_unicode
That's absolutely not categorically true; if you have an American HMO like
Kaiser they have price lists and cost estimators on their website. They also
have advice lines exactly like the post you're replying to. I can also email
my GP or message them through the app if it's less urgent.

~~~
takeda
Kaiser is very different than the rest of insurances. They have their own
facilities and prices are generally known in advance. Any other insurance it's
nearly impossible to know. You need to know if the facility accepts your
insurance or not (in/out of network), if the service is covered, your copay,
deductible, how much the place bills (note this is not how much they are
paid), what's the price the insurance company negotiated with the place and
actually will pay and bunch of other things. There's no single person who will
be able to tell you the price that you will pay. And you need to know a lot
and what to ask and who ask.

Unrelated to ER, I recently got charged almost $400 for a visit to a primary
doctor that should cost $35. Had to go back and forth with doctor bill,
hospital bill (apparently if doctor has an office in a hospital zone, they
will also issue a bill, even though you don't really use the hospital) and the
insurance company. I was going back and forth either side was either
everything is correct and that's how much I should pay, or saying that the
other side categorized it wrong. After attempting it multiple times.
Eventually I gathered enough evidence that when talking to person from
insurance she couldn't find excuse, then she suggested that I can submit
request to review it. Why didn't they suggest that from the start. Based on
information that I collected looks like the doctor's office and hospital
categorized everything correctly (despite what insurance person said), I even
had to figure out what the medical codes mean on the bill. And the issue is
that the insurance company made a mistake.

I like Kaiser model it makes things easy to know in terms of billing, but I
don't like that Kaiser give bonuses for doctors for minimizing costs. It
encourages so called marginal care. For example you generally won't learn
about new kind of treatments available from your Kaiser doctors. They will
generally suggest them if you're not responding to the cheaper solutions. For
example if you have an autoimmune disease they will prefer you to use DMARDs
and NSAID type of drugs (even with their side effects) and won't mention
biologics, which are much more expensive, but work much better and can often
reverse the effects of the disease.

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bloopernova
Question: What's broken about the economics of ERs such that more are not
being created to satisfy demand?

My assumption is that people are unable to pay their medical bills, but I was
wondering if there were other factors involved too.

~~~
microcolonel
In a lot of places, you need to ask permission before you're even allowed to
build a hospital. I think that fact, and the process attached to it, helps
keep the supply low.

~~~
robchachacha
Yup
[https://en.wikipedia.org/wiki/Certificate_of_need](https://en.wikipedia.org/wiki/Certificate_of_need)

~~~
hakka-nyu-su
That map shows California (which OP's article is about) as one of the states
where CONs are not needed

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nn3
They wait and wait and think and some point they realize how much the whole
thing is going to cost. That makes them reevaluate priorities and they leave
if they can. I bet things would be different if Health care had sane pricing.
Would be interesting to compare these numbers to socialized health systems.

~~~
I_Semmelweiss
you wouldn't have wait times in a for profit environment.

Customers would self select between ER, Clinic, and primary care visits if all
3 were priced accordingly.

HOwever, since ER = Clinic = Primary visit in price, people go to the most-
available choice. ER.

~~~
maxxxxx
Hospitals are for-profit but with no price transparency. So they can make
profit but their customer (patient) has no chance to make an informed choice.

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miguelrochefort
> 2017, the median ER wait time for patients before admission as inpatients to
> California hospitals was 336 minutes — or more than 5½ hours.

We have a similar problem in Quebec (where healthcare is "free"):

> 35 per cent of patients in Quebec — one in three — waited five hours or more
> for help in an emergency ward [1]

I was personally discouraged to receive public health care on 3 different
occasions, after initiating the process myself. Waiting times were always the
problem.

[1] [https://montrealgazette.com/news/quebec/quebec-has-worst-
eme...](https://montrealgazette.com/news/quebec/quebec-has-worst-emergency-
room-wait-times-health-and-welfare-commissioner-says)

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tarikjn
Not in the US, but a friend of my sister was bitten by a fox while she was
abroad in Mexico, it didn't look like anything bad, but her friend convinced
her to go to the ER to get it checked, the wait there was long and she ended
up leaving after 3 hours of waiting. She developed rabies and was repatriated
to France where she died a few weeks later. Nothing could be done because the
incubation period had already passed.

Please have insurance, and don't give up getting checked because it doesn't
look serious or you don't have insurance, and always schedule a follow up with
you GP as the ER only address urgent things for until you follow up.

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DoreenMichele
This is specifically about California, with a smidgen of data nationwide for
the US.

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maxxxxx
I think if there were more primary care doctors people wouldn’t go to
emergency rooms. You shouldn’t have to go to an ER if you have fever.

~~~
erentz
And 80% or more of what a primary care doctor does can comfortably be done by
any decent nurse practitioner. We should be encouraging the training of many
more nurse practitioners to take this load.

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aqme28
This is going to get a lot worse as boomers consume more and more healthcare
resources.

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aantix
How does it compare to countries with more socialistic medical care?

