The Problem Of Emergency Rooms

Financial burdens greatly limit the system’s accessibility; however, many in the U.S. are unable to fully utilize either option. Census estimates from 1999 indicate that 43 million Americans live without health insurance even though 75 percent of them have a full-time job or live in a household with at least one member working full-time (Mueller, , 5) In addition to the totally uninsured, census estimates also reveal that approximately 42 million other people in the U.S. are underinsured. This means that they have some insurance, but are still unable to afford all of their needed prescriptions, tests, visits to physicians, or hospital

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 U.S. health care system faces challenges that indicate that the people urgently need to be reform. Attention has rightly focused on the approximately 46 million Americans who are uninsured, and on the many insured Americans who face rapid increases in premiums and out-of-pocket costs. As Congress and the Obama administration consider ways to invest new funds to reduce the number of Americans without insurance coverage, we must simultaneously address shortfalls in the quality and efficiency of care that lead to higher costs and to poor health outcomes. To do otherwise casts doubt on the feasibility and sustainability of coverage expansions and also ensures that our current health care system will continue to have large gaps even for those with access to insurance coverage.

The lack of health insurance reached began to become a serious issue in the mid-1990’s reaching a crisis level in the 2000’s. Individuals without insurance turned to emergency rooms across the country to obtain care routine care, turning emergency departments into primary care facilities. In many instances, people who presented at emergency rooms for treatment could not be turned away due to various health and safety regulations; therefore, patients were seen without the ability to pay often leaving the hospitals with millions of dollars in uncollectable debt, subsequently leading to the insolvency of hundreds of hospitals across the United States.

Recently the Untied States top priority has been to provide accessible and affordable health care to every American. Those that lack access to coverage find it much more difficult to seek proper treatment and when they do they maybe left with astronomical medical bills. The CommanWealth Fund found that one-third or thirty three percent of Americans forgo health care because of costs and one-fifth or twenty percent are thus left with medical bills that have problems being able to pay. The federal government, through the Affordable Care Act (2010), has mandated that every person have health coverage in order

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 America, we not only have the problem of the non-insured but the under insured which causes just about as much problem as the underinsured. Each group has contributed to the vast growing cost of healthcare. Over the last decade or two, the amount of uninsured has risen due to the job market in the economy and the fact that most insurances are tied to employment, which is also a problem as the unemployment rate rises. The purpose of this paper is to explore this issue.

Not having health insurance makes a difference in people’s access to needed medical care and their financial security. The barriers the uninsured face in getting the care that they need means they are less likely to receive preventive care, are more likely to be hospitalized for conditions that could have been prevented, and are more likely to die in the hospital than those with insurance.  The financial impact can also be severe. Uninsured families already struggle financially to meet basic needs, and medical bills, even for minor problems, can quickly lead to medical debt. (McCarter, 2011)

After reading Delivering Health Care in America A Systems Approach 5th edition by Leiyu Shi and Douglas A Singh, a lot of topics stood out to me, but the one topic that really touches my heart is the topic about Uninsured Americans. Health insurance is currently an important issue in the United States today. Every day we see more and more Americans become uninsured due to unemployment and an increase in premiums. This topic is very important because working in a hospital setting you see so many patients that can’t receive the care they need because of not having insurance or their insurance not covering all of their needs. Hospital administrators face multiple issues everyday in regards to uninsured patients and underinsured patients. As health

In the current U.S. system the free market prevails and companies, in this case, major insurance providers “compete” for business. This competitive business approach should in theory drive costs down. For some reason, however, an argument can be made that it has produced the opposite result in profiteering. The nation’s largest insurer, UnitedHealth, boasted over a 10 percent revenue increase in 2013 according to Forbes (2013). Health insurance affordability contributes to the disparity in access to health care, as evidenced by the fact that there are millions that are still uncovered. A greater majority of certain minorities lack both health insurance and the financial resource to seek out either health care or insurance. While insurance companies reap huge profits the percent of private sector companies offering health insurance has dropped to less than 50 percent (Kaiser, 2013). There is decidedly a lack of coordination of care for this at risk population as well, since treatment is rendered sporadically and with continuously changing providers. The last major challenge is that of improving the quality of health care. According to a 2010 report by the U.S. Department of Health and Human Services, Office of Inspector General (OIG), an estimated 13.5 percent of Medicare beneficiaries experienced adverse events during their hospital stay and an additional 13.5 percent experienced a temporary

One of this health care’s programs objective is to limit the number of uninsured (Shi & Singh, 2015). This controversial healthcare plan incorporates a privately funded insurance which is paid for through employment and solely by the patient and a publicly funded insurance by the government. Medicare is provided for senior citizens 65 and older, and Medicaid is provided for low income citizens. The federal government and state government both partake in the funding of Medicaid. Although insurance is provided to the low income through Medicaid, the United States continues to suffer from cost escalation spending 17.1 percent of GDP on healthcare in 2013, a 50 percent more than the second nation (Commonwealth, n.d.) The high cost and limited coverage continues to spark up the conversation for a

The rising healthcare cost is an issue that affects many working class Americans. Experts have tried to come up with different ways to make health care more affordable and easily accessible to all. Despite all the efforts and even after the Affordable Care Act, there are still millions of Americans without health insurance coverage and therefore unable to access the necessary medical care. According to a 2015 report by the U.S Census Bureau, there are over 33 million uninsured Americans. (“Health Insurance Coverage in the United States: 2014 - p60-253.pdf,” n.d.) The Affordable Care Act has unquestionably made healthcare more accessible and reduced the number of uninsured Americans. However, there are still millions of

Individuals who are uninsured tend to be at risk in several ways. They include not having access to preventive care, holding back in seeking treatment may result into more serious illnesses thereby making treatment even more expensive for them to afford. Most public health facilities do not satisfy the needs of many uninsured Americans. Unlike their counterparts, uninsured individuals are

Concern for the care of the patient was one of the mitigating factor 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 in government payments to the institutions. Simply put if you want Medicare/ Medicaid payments you will abide by this law. There shouldn’t have been need for emtala 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 not being dismissed. 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, as they did not have way to pay for services, but still received treatment through emergency rooms.

Emergency room overcrowding is a major issue throughout not just the United States but in many countries. There have been many strategies on how to combat this issue as patient satisfaction is often being a major variable on hospitals being reimbursed, which interventions are most helpful? One intervention that is gaining more and more popularity is advertising wait times. Through a PICO search with key words of “ED triage” and “patient satisfaction” or “wait times” provided some great original research over the past five years that has been peer reviewed in the Journal of Canadian Association of Emergency Physicians. While multiple research papers came up, the methodology and potential of taking this particular study further was of great interest.