In my experience working in the Emergency Room as a technician, I have witness people abusing the healthcare system and utilize the Emergency Room as their primary care provider. Various reasons would bring these patients in, whether they are uninsured, illegal immigrants, or is unable to get an appointment with their doctors due to unavailability, inflexible office hours, or just unwilling to endure long waiting hour. Ideally, the Affordable Care Act that has newly insured 30 million people would alleviate the issue of individuals using the Emergency Room for nonemerging needs; however, without addressing the workforce shortage in primary care setting the influx of newly insured patient would just over flow the system. Although urgent cares
A visit to the emergency department (ED) is usually associated with negative thoughts by most people. It creates preconceived images of overcrowded waiting rooms and routine long waits for treatment (Jarousse, 2011). From 1996 to 2006, ED visits increased annually from 90.3 million to 119.2 million (32% increase). During this same time period, the number of EDs has declined by 186 facilities creating the age old lower supply and greater demand concept (Crane & Noon, 2011). There are many contributing factors that have led to an increase in ED visits. A few of these key drivers include lack of primary care access, rising of the uninsured population, dwindling mental health services, and the growing elderly
Situations like Maria’s have become fairly common here in the United States. In 2014, Pew research estimated that there are 11.3 million unauthorized immigrants in the United States (Krogstad & Passel). In 1986, the Emergency Medical Treatment and Active Labor Act (EMTALA) made it possible for unauthorized citizens to qualify for Emergency Medicaid. Moreover, any hospital which is eligible to receive Medicaid reimbursements is required to treat ANY patient with emergency medical treatment (Sultan). Prior to the Affordable Care Act (ACA), hospitals could also receive reimbursements for patients who those who needed non-emergent
The new federal health-care law has raised the stakes for hospitals and schools already struggling to train more doctors. Evidence suggests there won’t be enough number of doctors to treat the newly insured millions under the ACA. At current graduation and training rates, America faces a shortage of as many as 150,000 doctors in the next 15 years, according to the Association of American Medical Colleges. The greatest demand will be for primary-care physicians. Emergency rooms, the only choice for patients who can't find care elsewhere, may grow even more with longer wait times under the new health law. That might come as a surprise to those who thought getting 32 million more people covered by health insurance would ease ER
They argue that nearly 70 percent of Texas physicians are reluctant to see Medicaid patients due to low reimbursement rates (7). They claim this to be the prime reason why patients seek primary care services at the emergency department (7). In contrast, supporters of Medicaid expansion argue that uncompensated care is the fundamental basis for Medicaid expansion, as increasing the number of people with Medicaid coverage will lower the unreimbursed costs to the hospitals (7).
But for the rest of the population substantial disparities still exist. This problem not only affects the uninsured population and the communities they live in, but the entire nation's economy. Dozens of hospitals in Texas, New Mexico Arizona, and California, have been forced to close or face bankruptcy because of federally mandated programs requiring hospitals to provide free emergency room services to illegal aliens. Safety net hospitals continue to operate under a heavy burden of providing care to this largely uninsured population (Torres, Steven, & Wallace, 2013). Having access to healthcare is a necessity in maintaining the good health of these undocumented immigrants. Several solutions have been proposed to overcome the barriers affecting undocumented immigrants. One solution would be to expand the coverage of the Affordable Health Care Act for this population. Another solution would be to approve an amnesty bill to alleviate the undocumented immigrants' situation in the United Sates, which would allow them to access public health
In the early 1980’s there was increased observation by emergency room physicians that patients were being transferred or dumped from private hospitals to public hospitals based on their inability to pay. Concern for the care of the patient was one of the mitigating factors for our nation’s development of Emergency medical treatment and labor act (EMTALA) . Enacted by Congress in 1986, EMTALA was government’s way of ensuring basic screening, stabilization and care for all patients. Non participation with EMTALA was not an option, since the law tied government payments to the institutions. Simply put, if you want Medicare/ Medicaid payments you will abide by this law. EMTALA would not have been needed since there were already safeguards for indigent patients, but they were not followed, rather seen as guidelines. With the backing of EMTALA, patients had better care assurances, and guarantee of non-dismissal. The Joint Commission on Accreditation of Hospitals stated that “individuals shall be accorded impartial access to treatment or accommodations that are available or medically indicated, regardless of race, creed, sex, nationality, or sources of payment for care” It has been strongly inferred that based on the implementation of emtala, increased numbers of uninsured were using the emergency rooms as their primary source of care. The thought was those without insurance, did not seek preventative care through a primary care doctor,
The Affordable Healthcare Act is expected to increase medical coverage to include an additional 30 million people. What has become clearer is that just because coverage was expanded does not mean an expansion of actual care. “When Congress enacted the national health law, it unleashed a potential tsunami of newly insured patients, flooding a delivery system that was already strained and fragile. The American health care infrastructure has had workforce shortages for decades and is not prepared to meet such a vast influx of patients effectively or
Emergency room over utilization is one of the leading causes of today’s ever increasing healthcare costs. The majority of the patients seen in emergency rooms across the nation are Medicaid recipients, for non-emergent reasons. The federal government initiated Medicaid Managed Care programs to offer better healthcare delivery, adequately compensate providers and reduce healthcare costs. Has Medicaid Managed Care addressed the issues and solved the problem? The answer is ‘Yes’ and ‘No’.
In the area of healthcare, the influx of illegals has proven to put a huge burden in all areas of the system. In California over the last decade many hospitals and emergency rooms have closed due to the illegals being treated there and not being able to pay the bills from the hospital. Right now, California out of the 50 states is last in the number of emergency rooms per million people (Jones, 2012, #6.). The insurance premiums for citizens keep increasing because when the illegal’s go to an emergency room
When focusing on the Centers for Medicare and Medicaid Systems strategies for improvement with unnecessary emergency room visits, a major key area is accessibility to health care at the appropriate health care setting. For many years, there has been the perception that the emergency department is the only place for someone who is uninsured or underinsured can go to receive the needed and appropriate health care, and in some situations that may be the case. (Rhodes et al, 2013, p.394) Due to the decreases in reimbursements for the publicly funded, more and more physicians are opting out to treating these patients, thus leading to an increase in emergency department utilization. According to a study conducted by Rhodes, Bisgaier, Lawson, Soglen, Krug, and Haitsma, this is becoming a greater concern for the
The ACA was created to help insure a larger portion of the nation’s population and give people access to affordable and higher quality care. Unfortunately, the ACA completely excludes undocumented immigrants from the eligibility of the program, even though this population consists of 11 million, which is a huge chunk of the nation’s population. As a result, the undocumented population is left with Emergency Medicaid, which is a program that is a part of ACA. This program gives some limited assistance to undocumented individuals in a case of an “emergency” or pregnancy related issues. Emergency Medicaid does not cover any type of prevention care or offer primary physicians to patients. It is also important to note that if the hospital determines that the visit was not an emergency, then the patient is left with a high medical bill that they would not be able to afford possibly leading to bankruptcy.
Illegal immigrants usually hold jobs that have bad conditions and worse pay. Oftentimes, these jobs are found in sectors such as agriculture, construction, food-handling and manufacturing (Dwyer). Unfortunately for the illegal individuals who acquire these jobs, they have no access to comprehensive health care, though their line of work tends to demand it. Although illegal immigrants are consequently strapped for cash, many of them will not visit primary care physicians for fear of being deported. This sets up a vicious cycle: individuals get sick yet ignore the signs. When illnesses get remarkably worse and are too severe to treat at doctors' offices, the individuals then go to emergency rooms, where the cost is considerably greater. More often than not, the immigrants cannot afford to pay their hospital bills. The cost is then covered by the medical institutions and tax-payer dollars (Wolf). While some argue that illegal migrants do not
There needs to be an urgent reform of the Obama affordable health care act. The Obama health care act perhaps was an attempt to solve the solution of the American health care crisis. Obama care has created another crisis. Even those with health care coverage can not afford the out of pocket expenses. Emergency rooms are not adequately prepared for the increase in the volume of patients. Health care workers are becoming overloaded and elevated stress levels. There must be a cap on all health care cost for medical treatment. The middleman needs to be cut out. Middleman includes county clinics (on government funding who take advantage) , medical referral services, pharmaceutical company 's, and the health insurance company 's.
In virtually every community in this nation, the emergency department (ED) is an integral part of the health care safety net, often serving as the only available point of access to the health care system for many vulnerable and disenfranchised individuals. The authors present a brief overview of the March 2000 report released by the Institute of Medicine that described and assessed the current status of the nation's health care safety net. The authors discuss the role of the ED as a safety net provider and as a window onto the status of the rest of the health care system. The authors describe the Andersen behavioral model of health services use and suggest it as a useful theoretical framework for emergency medicine researchers who are interested
The emergency room has become the new primary care facility for the millions of uninsured in the United States. Thanks to an “unfunded mandate passed into law in 1986,” hospitals that participate in the Medicare program must “screen and treat anyone with an emergency medical condition” (Stephens & Ledlow, 2010). This unfortunately leads to emergency rooms full of people who may have something as simple as a sinus infection which then makes it really difficult for someone with a real emergency that did not require ambulatory transport to be seen in a timely manner. Another unfortunate result of this is that “over 1,100 emergency departments closed over the past decade” (Stephens & Ledlow, 2010).