Monday, September 17, 2012

My Ideas for Fixing Our Healthcare System, 3

     In my healthcare system, 90% of ER services would be eliminated.  The ER is wasteful and redundant, and has become a bad habit for many Americans.  The many services billed from ER's could be be provided, if needed, at the patients' primary care offices.  A national registry of services already provided to the patient would prevent duplication--as when a patient with chest pain goes to one ER one week, and another the following month, and both hospitals perform the same expensive work-up, not knowing or caring that it may have been done already, because the information is not immediately available.
     Since most hospital admissions come through the ER, 90% of hospital care could also be eliminated.  The only necessary hospitalizations would be for true emergencies--auto accidents, heart attacks, and emergency surgery for appendicitis or other acute conditions.  All other surgeries could be accomplished in outpatient surgicenters, which already exist.
     A huge increase in preventive services, as outlined in a previous post, would eliminate the need for many hospitalizations and surgeries, especially the ones related to auto accidents and health-eroding lifestyle choices.  Since programs like Weight Watchers, drug and alcohol detox and rehab, gun safety, effective parenting, anger management, prenatal care, infant care, timely immunizations, automobile safety, and group, family, couple and individual counseling would be free--and sometimes mandatory--many of the precipitants for injury and disease would be eliminated, resulting in a healthier population.
     The number of primary care physicians would have to increase by a factor of ten or twenty.  In addition to providing preventive care, family physicians would be the ideal choice for manning twenty-four hour clinics that would replace emergency rooms.  Physicians could be paid, as shift-workers are already paid in hospitals, at higher rates to compensate them for the inconvenience of covering evening and night hours at these clinics.  In fact, many primary care offices could be open twenty-four hours, with more minimal coverage at night, based on the population and needs of the community.  Unlike today's emergency rooms, these clinics would have electronic access to every patient's health history.  Physicians and nurses would be trained to screen patients to identify true emergencies, and would schedule the non-emergencies for next-day appointments, thereby teaching patients the meaning of "emergency."
     In our current medical system, patients are rewarded with full-spectrum and irrationally expensive services whenever they show up at an emergency room, thereby reinforcing their belief that they "needed" to go to the ER, and that ER's give excellent care.
     I have had patients who called the ambulance to take them to the ER in order to get a "free" pregnancy test, or who showed up to get "a second opinion."  Many patients go to the ER to manipulate doctors into giving them pain pills.  ER doctors routinely give out five or ten pain pills when these patients show up, because they don't know the patients and prefer to err on the side of being compassionate thinking--but this protocol reinforces the patients' bad behavior, and costs the taxpayers hugely.
     In the revised medical system, patients who do not have true emergencies would be turned away from clinics when they show up in the evenings or at night.  They would be screened efficiently, and given appointments for sick--but not emergency--visits the following day.  These visits might be combined with the six month preventive visits, at which time an assessment could be performed to identify factors that caused a sickness in the first place.  If the healthcare system worked properly, very few people would ever get sick.  Since most sicknesses have psychological underpinnings, counseling services for everyone would be an essential component of an effective medical system.  One's own psychological awareness is a key factor in controlling physical symptoms, accident-proneness, and susceptibility to disease.   

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