How do indigent people afford ER bills? Thousands of dollars a visit.

[OILFIELDTRASH]

Meg - one of the best posts of the year, should be required reading for everyone who thinks that 'universal' health care is evil

I hate politics but I have to say that universal healthcare is the same as what we have now. If the indigents are sucking the system dry now what's universal healthcare going to change? The indigents are still well.. indigent and I'm still footing the bill.

 

[classy]

I worked for a hospital system, if the person can not pay it goes under charity care. Most hospitals shouldn't show a profit and this is part of the reason many don't. It may not be called charity care at every hospital but something to that effect. The state will usually pick up the tab in some way. The hospital will usually research thoroughly if the person can pay though.

 

[mattpegher]

Shit, forgot about the rest of the hospital. How bout instead of an ER attached to the hospital, it's an Urgent Care attached to the hospital. Pay for the care, and off you go.

No pay, go find a hospital with an ER not an Urgent Care

This model is an ever increasing trend, but the laws regarding hospital owned Urgent cares make it difficult for the hospital to avoid violating what is called the "Emergency Medicine and Active Labor Transfer Act, EMTALA". There is nothing keeping non-hospital companies from opening Urgent Cares that require payment at the time of service, yet.

And as CT and laboratory technology gets less costly and more portable, this will be possible.
You will still need to transfer patient to the hospital if they require admission, or surgery. Of course, life threating illnesses like heart attacks, strokes etc, would need to be transferred to the ER as fast as possible.

Part of what prevents this is the mountain of regulations that control laboratory and radiology. The cost of licensing and inspecting a moderate outpatient lab is about 100k/year. But as the emergency medicine system colapses this will become a viable option.

 

[mattpegher]

I worked for a hospital system, if the person can not pay it goes under charity care. Most hospitals shouldn't show a profit and this is part of the reason many don't. It may not be called charity care at every hospital but something to that effect. The state will usually pick up the tab in some way. The hospital will usually research thoroughly if the person can pay though.

Actual most hospital do not show a profit and live off of charitable contributions/endowments. The days of a hospital being profitable are long gone. Charity care subsidizes some indigent care but only about 10%. And even for those it only lesses the losses. Most hospitals are not directly funded in any way by the state.

 

[Zedtom]

There will always be charity and compassion for the poor. Some people find that difficult to justify and believe that the needy are ripping off the rest of society. I can be accepting of people and their plight, but I have my limits.

My pet peeve is people who did not grow up in the US who come here when they are elderly and throw themselves on the mercy of the American taxpayer. They somehow have no assets, no possessions and no relatives to help them but they have found a way to get here. Our nursing homes give them a free ride and have to write off their expenses or hope that Medicaid pays part of the bill.

 

[zinfamous]

I hate politics but I have to say that universal healthcare is the same as what we have now. If the indigents are sucking the system dry now what's universal healthcare going to change? The indigents are still well.. indigent and I'm still footing the bill.

the main difference is eliminating (well, significantly reducing) the use of the ER for these services. that cost, compared to urgent care, is ASTRONOMICAL.

 

[mizzou]

You pay it for them.

this

 

[mattpegher]

The problem is even if you establish free clinics for the indigent, they will still use the ER for the convenience. Why get an appointment if you can walk in and get seen today. Why go to the clinic and wait if the wait is less in the ER. If the wait is not less in the ER then seriously ill patients will end up waiting too.

The only answer is to change the law to allow for a triage nurse to determine that your problem can wait to be seen in the clinic. As for now, you cannot be discharged from the ER until a physician evaluates you. One answer is staff the triage with a nurse practicioner, the triage becomes the medical screening exam. But there has to be somewhere for them to be sent, at this time there isn't.

 

[0roo0roo]

short sighted policy = u pay through the nose
http://www.gladwell.com/2006/2006_02_13_a_murray.html

 

[mattpegher]

I actually see a trend, and it depends on the way health care is financed in the next 10 years.
So you break your arm. Have abdominal pain, or need stitches.
You have two choices. You will be able to recieve the same physicians, same test and same care.
1. You can go to a private Urgent Care, that sees only paying patients. You will be seen within an hour or two. Your bill will be about $300-800. You have a participating insurance or are using an HSA and have a high deductible plan (what I have now). You are home in about 3 hours.
2. You can go to the ER. You will have to wait about 3 or 4 hours to be seen. You will recieve the same excellent care. You will be billed $1500-3000 depending on tests. You will be sent home in about 6 hours.

I already see a desire in my community. People would rather see me in the Urgent care than have to see me in the ER.
I have a CT scanner, Digital radiology.
the ability to splint and suture repair.

Need a lab (had one but licensing got too expensive)
need ultrasound.

after that I would have everything I need for 75% of the patient I see. Could then transfer anyone that needed hospitalization or stat specialist eval to the ER.

 

[Mo0o]

I actually see a trend, and it depends on the way health care is financed in the next 10 years.
So you break your arm. Have abdominal pain, or need stitches.
You have two choices. You will be able to recieve the same physicians, same test and same care.
1. You can go to a private Urgent Care, that sees only paying patients. You will be seen within an hour or two. Your bill will be about $300-800. You have a participating insurance or are using an HSA and have a high deductible plan (what I have now). You are home in about 3 hours.
2. You can go to the ER. You will have to wait about 3 or 4 hours to be seen. You will recieve the same excellent care. You will be billed $1500-3000 depending on tests. You will be sent home in about 6 hours.

I already see a desire in my community. People would rather see me in the Urgent care than have to see me in the ER.
I have a CT scanner, Digital radiology.
the ability to splint and suture repair.

Need a lab (had one but licensing got too expensive)
need ultrasound.

after that I would have everything I need for 75% of the patient I see. Could then transfer anyone that needed hospitalization or stat specialist eval to the ER.

Arent there some smaller hospitals with EDs that's essentially doing what youre saying? Much lower volume so much lower wait times but without the level 1 capabilities of a large county ED

 

[BUTCH1]

Keep in mind a lot of employers will not hire full-time just so they do not have to offer benefits or offer crappy coverage that's almost useless. Even with large corporations insurance can be expensive, I work for a large multi-national company (one that keep going) and Cigna HMO for myself and wife is $123/week, it's getting insane. It does piss me off when I find out that someone has insurance offered through an employer but opts out and then gets sick so all the rest of us paying saps get to foot the bill..