Why Emergency Rooms Are Packed, Ctd

A reader writes:

People are kidding themselves if they think urgent care centers can “de-crowd” emergency departments.  The latest number from the CDC on non-urgent visits to ERs is less than 8 percent.  Non-urgent means a patient who needs to be seen in 2-24 hours, mind you, not a patient who is there for a hangnail.  Remove the 8 percent non-urgent patients from America’s emergency departments and you still have 114 million people seeking emergency care every year, a number that is likely to grow.
Emergency departments are crowded principally because of “boarding,” the practice many hospitals engage in whereby admitted patients are held in the ER.  Those held patients need to be monitored by emergency department staff, which prevents them from attending to new patients coming to the ER.  This is what leads to crowding and long wait times.  The rash of ER closures hasn’t helped matters as it has compressed more people into fewer ERs.   ERs close because of the rising burden of uncompensated care that ERs provide due to uninsured or underinsured patients (i.e. Medicaid).

The number of urgent care centers has continued to climb as has the number of emergency patients.  Urgent care centers provide a service, but it’s a dangerous fantasy to think that they can handle a load of emergency patients sufficient to eliminate ER crowding.  They lack the staff, expertise and resources to handle any real emergencies, and the wrong patient visiting an urgent care center in order to save money or time could well cost himself his own life.
Another fantasy people have is that emergency departments are eating up a huge chunk of the U.S. healthcare spending.  Not true.  Currently emergency care eats up only 3 percent of health care dollars.

Another reader:

When I hear about people using emergency rooms for what is essentially primary care because they can't get access to a doctor during regular business hours, I think of two features of the French health care system that help make this unnecessary.  First, French pharmacists are trained and authorized to do some diagnosis and to prescribe at least some drugs, without needing an order from a doctor.  In the U.S., if you have an ear infection and need antibiotics, you have to see a doctor for a prescription, even if the only way to see that doctor is to go to the emergency room.  In France, you go to your neighborhood pharmacy, the pharmacist looks at your ears and throat and prescribes a basic antibiotic.  (And in larger cities and towns, the pharmacists work out a rotating schedule to ensure that there is always one pharmacy open, with a pharmacist available, for overnight medical needs.)
But even better is SOS Medecins.  In 60 or so of France's largest towns and cities, you can call 24 hours a day and, after some telephone discussion to help determine whether you really should go to an emergency room, a doctor will come to your house.  Poking around their (not well-designed) website, it looks like they receive about 4 million calls a year and make 2.5 million housecalls.  About 10% of calls result in them telling the caller to call an ambulance, and a large number are able to be resolved without a visit (with the doctor taking the call able to help the caller determine that his or her condition does not require urgent care).  And the cost is significantly less than a visit to an emergency room.  The service was started over 40 years ago by a doctor who realized it was easier to get a plumber to come to your house on an emergency basis than it was to get a doctor.
Like the urgicenters and community health centers other readers have described, these are just a couple of commonsense ways we could help reduce medical costs in the U.S.