The High Cost of Emergency Medicine
We talk about the high cost of care delivered
in the emergency department. That is incorrect. The reality is
that it is low cost. Yes, "high charge," but low cost.
There is no savings in diverting patients
from the emergency department, especially when there is no place
for them to go. It is unconscionable to deny them access to care
without giving them alternatives. Therefore, should routine patients
be treated in the emergency department? The politically correct
answer on the surface seems to be "no." Will there be
a cost savings if we move routine patients out of the emergency
department? The reality is "no". Diverting routine patients
will, in fact, increase healthcare costs as alternative or more
"appropriate" access points will have to be created.
So, if it is going to cost more to divert
patients to other access points, and there will be no cost savings,
then why do it? Because many feel it's the right thing to do.
Some feel that emergency department care for routine patients
is damage control care and certainly not preventative care.
It is also felt that it stresses the emergency
department's systems, such that the care available for patients
with emergencies is diluted. So, yes, there may be legitimate
reasons to divert routine patients from the emergency department,
but it is not cost. To successfully divert these patients, we
will have to invest additional dollars into health care, creating
additional access points and primary care capacity. This will
mean additional spending, more of our gross national product spent
on healthcare.
There will be no savings in the cost of
maintaining our emergency departments by seeing fewer patients.
Why? Because the emergency department represents primarily fixed
costs, which will not, cannot, be reduced by sending patients
away. So, then the question, "What is to be gained by moving
routine patients from the emergency department to alternative
points?" It is to move their care from an area of episodic
care to one of continuity and preventative care.
This will also improve care for those with
emergencies, as the emergency department's resources can then
be fully applied to emergencies and urgent patients, where their
care is currently diluted to some extent by routine patients.What
is diluted emergency care? It's long waits, decreased physician
time per patient, decreased nursing time per patient, ambulance
diversions, over crowded conditions, less time for the art of
medicine, and less time for compassion. So, what should we do?
We need to invest more in healthcare. We need to fund additional
access points, more clinics, and more primary care. Is this going
to cost us more? Yes. Is it the right thing to do? Yes. Will we
do it? I don't know.
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