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Blueroses's avatar

Is there a humane and compassionate way to renovate medicaid and serve us all?

Asked by Blueroses (18256points) November 17th, 2012

I work for a charity hospital. I’m grateful for being a part of our mission statement: “To treat every person with premium care, regardless of ability to pay.”

Here’s the rub. Medicaid pays fully for any ER visit. This means our ER is full 24/7 with people who use the ER as their family doctor.

I don’t blame them. You get seen immediately, get your script and get out. It’s much faster than going to a community clinic.

Second part of the rub: At least here, community clinics take no longer than private practice to see patients. It costs us all a hell of a lot to go to the ER, even with insurance (because it costs a hell of a lot to staff an ER)

How can we give good care to the poor and maintain a prime ER for everybody? I think it has to be a penalty/copay for using the ER as a regular doctor. Thoughts?

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17 Answers

poisonedantidote's avatar

Can you have a doctor in the ER, or a nurse, who sees the patients the very instant they come in, and assess how serious their condition is?

If you come in having a heart attack you get allocated code red, and are seen right now. if you come in with your head smashed in and bleeding you get code orange and are seen right away as long as there is not a code red patient before them. If you come in with a broken leg you get code yellow, and will probably have to wait a while, if you come in with back pain you get code green, and if you come in for a prescription for flu you get code blue and wait the longest.

My main goal would be to not have a fee or penalty for these people, as they sound like they are doing this out of necessity, and charging a fee may prevent some from having a doctor at all.

Maybe you could ask patients for donations after they have been given treatment if money is what is needed. Or maybe you could have a fun raising campaign that is run constantly.

There are plenty of ways you could raise money online from people who are more fortunate. If you wanted further advice and help with that, I could always help you out and point you in the right direction.

jca's avatar

@poisonedantidote: That’s called a Triage Nurse and every ER has one. Triage nurse does assessment and determines who’s first in the pecking order of injuries/illnesses. Stabbings, shootings go before colds do.

LuckyGuy's avatar

There should always be some penalty or cost otherwise there is positive incentive to abuse the system.
You might offer one free visit every 2 years then they must pay a large penalty and the debt gets reported to social services and section 8. If they want to earn another free visit, they must work 20 hours for an approved charity or service, soup kitchen, salvation army bell ringer, etc.
I do not believe in any free lunches. Ever. Unless you are disabled and in a vegetative state you must do something functional to help society.

GracieT's avatar

I have been to a local ER several times since my husband and I moved into this area. All of the times have been because of real emergencies, because of being unable to go to my regular doctor (time of day or day of occurrence.) In every case but a couple- almost literally just two times, I have been treated by uncaring idiots 1.) an attending who when I reported his incompetence to the chief if staff in the ER (I had to go back for the lack of care and it was the middle of the night,) 2) because of my husband having to actually remove the blood pressure cuff because of the nurse using it making me turn blue, or the amount of time I had to wait because of the number of people in the ER (despite my having a throat swollen to the point of having trouble breathing by a reaction to a medicine.) I’ve been taken to the ER also sometimes because of seizures. My husband and I do have a family physician. I guess my point is that the care in ERs (at least the one closest to us) is NOT always acceptable, and people don’t always go because of not wanting to avoid having to deal with the trouble and or cost of having a regular family doctor. Why would they chose to deal with this incompetence if they had alternatives? I know that not all ERs are this bad, but seriously…

@poisonedantidote, when I lived in another city near the one I live in now we had an ER that had four sections, with different patients sent to each by the Triage nurse. One was for life and death, two for regular cases, and one was specifically for patients using the ER as their family doctors. It seemed like the patients taken to the other areas there did not have as long of a wait as the hospital ERs near us now.

jaytkay's avatar

The solution is Medicare for all.

I know elderly full-on Tea Party conservatives who LOVE Medicare (although they think other people don’t deserve it.)

It works, it’s much more cost effective than private insurance.

GracieT's avatar

@jaytkay, unfortunately it doesn’t always work- I know people who cannot afford medicine despite being on Medicare and they have actually had to cut pills in half. I agree with you in that sometimes it is more cost effective than private insurance, maybe even generally, but sometimes it isn’t.

poisonedantidote's avatar

Yea, I got the idea from our hospital here. What I was getting at, is you could give them a time penalty other than a monetary penalty, for showing up with things that are not really emergencies.

zenvelo's avatar

I’m along with @poisonedantidote, the ER needs a triage nurse that routes people who are using it for a clinic to a Nurse Practitioner, who can see them, and tell them they have to go to a clinic. If people who are merely sick are not given ER treatment, but sent away to a clinic, it would help the whole sstem.

And by having health insurance for all, preventive medicine can help the load on ERs by getting issues addressed before they becom critical.

GracieT's avatar

Unfortunately, @jaytkay, @poisonedantidote, it seems like not all ERs have thought of that. I agree with you both, it is a simple solution. Of I don’t work in an ER, so I may not have any idea what I’m talking about!

jaytkay's avatar

@GracieT Drug prices are a problem because insurance lobbyists and the Republicans deliberately prevented drug discounts. They worked very hard to keep friend’s from getting cheaper pharmaceuticals.

Like all of health care, we are stuck with half-assed measures thanks to the tireless efforts of conservatives to assure that “health care” dollars flow to insurance companies in stead of towards health care.

The way to provide affordable medical care is to, you know, provide medical care.

Instead we have a delivery system that costs twice as much as health care in every other first world country. Because we pay for lots of unnecessary insurance and administration.

GracieT's avatar

@jaytkay, I agree with you entirely. I know people (amazingly enough, Republicans all!) that think that the US medical system is the best in the world, and point to government run medical care as nothing short of criminal. One points to all of the malpractice cases ( I agree with him to some extent.) If I dare to point out the truth (believe me, I’ve tried!) they look at me with suspicion, like I’m from Mars. These are friends, and, of course! they have nothing seriously wrong. What’s strange, though, is that two of them cannot afford the care they really need, nor the medicine that would help treat the conditions they live with!
go figure! :@)

YARNLADY's avatar

Many people are convinced the government cannot properly administer a medicare for everybody type program, and they are unwilling to support it.

Those people are financially supported by private insurance companies (read big corporations) and they are trying to convince the American people that the only way we will get medical care for everyone is to give money to the insurance companies.

It is easy to convince people who blame the government for everything rather than actually get involved and create change through the system.

jca's avatar

@jaytkay @GracieT @YARNLADY: You all refer to Medicare, but the question refers to Medicaid. You are aware that there is a difference between Medicare and Medicaid, aren’t you? Medicare is for the elderly, Medicaid is for people who qualify by their income.

YARNLADY's avatar

@jca Oh, yes, I misspoke. Sorry.

jrpowell's avatar

@jca :: Just for the record. People on disability get Medicare too.

jaytkay's avatar

@jca Yes, thanks for mentioning that, the programs do get confused.

I brought up Medicare, because if we had Medicare for all, there would be no need for Medicaid.

jca's avatar

@johnpowell: Yes, I am aware of that, but the three people I mentioned referred to Medicare and the question referred to Medicaid. It seems like they mixed it up.

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