Choosing better, US style

Short White Coat blogger Ishani Ganguli marvels at a frank UK ad (advert?) discouraging people with non-serious illnesses or conditions from clogging up the emergency room. It shows a line of people who shouldn’t be there. At the end is a wreath, representing a heart attack victim who should have been first in line.

She wonders aloud why we couldn’t have that kind of campaign here and answers that problems include access to primary care, the perception that going to the ED would be quick, and that primary care referred them to the ED.

These factors are all legitimate, but there’s more to the story. Emergency departments can be profitable and are a major feeder for inpatient admissions, so hospitals advertise them. You don’t have that in the UK. That advertising also leads to the perception that the hospital is a better place to be seen, so even patients who could get access to their primary care physician don’t try.

My health plan (Blue Cross) and others have what are euphemistically referred to as “demand management” services. In my case I can call and speak with a nurse who can steer me in the right direction, whether toward self-care, the emergency department, primary care, a specialist or the pharmacist. I’m not sure these things really save the health plans any money, but I also don’t know whether the UK ads work.


2 thoughts on “Choosing better, US style”

  1. EDs “can” be profitable – and water “can” be wet


    Treatment location triage makes intuitive sense – but when smartphone applications with locator features, like the one recently purchased by a major health insurer, used to be sold to hospitals as a way to BOOST ED traffic, it’s clear the good old “alignment of interests” challenge looms large here

  2. ED are not the pot of gold they once were….
    They remain a feeder — but only if the patient has medical needs that can only can be addressed at acute level of care.
    Costly services provided in the ED to a subsequent inpatient admission is bundled into the hospital fixed rate payment – the hospital does not get separate reimbursement (the doctors do, but not hospital).
    Primary care docs refer their patients to the ED because they don’t have time to see them immediately … so the next question that should be asked is why doesn’t the hospital have a walk in primary care service. Ah ha !
    The reasons are:
    1) community doctors will balk that the hosptial is trying to compete with them and use that old saw “I’ll take my patients elsewhere if you do that” – “that” could be whatever new initiative the c-suite is thinking about that the doctors don’t like.
    2) EMTALA regs apply to any sub-set of the ED – so even if the hospital has a ‘urgent care’ track, patient must still must be medically cleared.
    3) Walk in primary care is best provided when separate from the hospital….that’s why retail practices have been so successful.

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