Elective vs Urgent vs Emergent

Filed under: by: Hey Doc Wait

Just a quick thought, inspired by these propaganda ads I've been seeing tonight. The ad I'm referring to bashes Canadian health care and threatens that "Washington" wants to enact Canadian-style health care in the US.

I'll get further into all of this at another time. My current beef is this: a lot of what Americans find appalling about Canadian or UK health care is the idea of rationing or waiting for procedures. When you look at the procedures that, on average, people are waiting months for, they are elective, non-emergent procedures. I'm not saying that these systems are perfect, or that problems don't happen--there have been a few well-publicized cases of people with cancer diagnoses waiting months to start treatment in Canada--but overall, people with cancer or other life-threatening diagnoses usually receive timely treatment.

What they're waiting for are things like knee replacements. While knee arthritis is certainly painful, it is usually not life-threatening. I'm not arguing that it's not a quality of life issue--I like to be able to walk--but when we're talking about an elective issue, if you want it faster you should have to pay for it yourself, and if you're unable to pay for it yourself and need the government to do it for you, then you may need to wait.

I think our inability to tell life-threatening from urgent from non-urgent is something that is helping to drive up our healthcare costs in this country (amongst the 99 billion other things doing so). People going to the emergency room with "I had asthma symptoms yesterday but not today", whether they are insured or not, are helping drive up our costs. People who demand their elective procedures NOW--and can pay for them--are helping drive our healthcare system towards specialists and proceduralists, as graduating medical students can attest.

Perhaps it should be like 911. If you call 911 and it's not an actual emergency, and you abuse the system repeatedly, you can be fined or even arrested in most places. I think regardless of whether you have insurance, Medicaid, or nothing, if you abuse the emergency room you should pay a fine. Or, maybe the answer is to charge a fee to come into the ER at all. After all, with my insurance, I have a copay to use the ER (and it's not little). So, I have to decide how emergent things really are. Now, this copay is waived if I get admitted to the hospital from the ER--one way of potentially gauging the severity of my complaint. There are some things that may need treatment in an ER that may not require an admission--broken bones that can be set, abscesses that can be drained, lacerations that can be sutured, etc--but would be totally worth the copay, in my opinion.

Anyway, there are a lot of problems with the ad and it's premise, but I wanted to go off on a tangent. Because I can.


On July 26, 2009 at 12:17 PM , TB said...

Hmmm...Don't we already ration healthcare? Isn't that what happens at the hospital you work at everyday? That ad is clearly targeted at the insured population who are used to being able to go to the doctor when they want and get treated according to their schedule and not just having to wait for a phone call from TB general saying what day and what time they are scheduled to see their doctor - with no one asking the patient when would be better for them.

It's obvious that doctors didn't come up with the idea of "never events". A system of beaurocrats and lawyers decided that one. What makes me afraid of completely government run medicine is that some guy that Pres O knew from law school who has no experience in either business or medicine, like the guy running GM who has no experience in automotives or business, will end up telling me and all other doctors that I won't get paid if I decide that the risk of massive hemorrhage outweighs the benefit of DVT prophylaxis. Or that I won't get paid for treating high blood pressure if the patient's blood pressure doesn't get controlled - regardless the compliance of the patient. Or not being paid if a patient, who had deliberate hypothermia in the OR arrives to the PACU with a temp of 35.9C instead of 36C.

Not that insurance companies aren't also headed towards these systems either.

I don't believe the system we have now work well, and don't think that a rushed plan that is being pushed through because of a "now or never" sentiment over the current filibuster-proof legislative branch in Washington could possibly be the solution either.

Problems that take a long time to develop take a long time to fix.

Our current medical system is like a chronic sodium of 115. If you try and fix it fast, we're all going to end up vegetables. The right solution, whatever it is, is going to take time