Hospital Costs: The ER Visit

We’ve talked about America’s high costs.  One reason is our overuse of ER’s for outpatient care.

The medical mafia makes a big deal about the “sacred” patient doctor relationship.  My experience the past several years is that first, there is nothing sacred going on here and second that the relationship is a somewhat romantic figment of our imagination–it no longer exists.

You realize, of course, that the solo practitioner has gone the way of dinosaurs.  For virtually everyone your family doctor (of one sort or another) is part of a group practice.  When you become ill more often than not you family doc, the guy/gal you have the sacred relationship with, is normally fully booked and you see another practitioner/nurse/physicians’ assistant.  Your doc may or may not even be aware that you have had a problem.  If you are hospitalized your care is turned over to yet another provider, the hospitalist.  Another doctor you have never met.

It’s even worse than implied above.  If you should have an emergency of one sort or another, real or not so real, you are advised to go to  the ER.  That shifts the responsibility for your care elsewhere and quite remarkably escalates our costs to unimaginable levels.  The “sacred” relationship is nowhere to be found.

Elizabeth Rosenthal of the NY Times discusses ER costs here.

A day spent as an inpatient at an American hospital costs on average more than $4,000, five times the charge in many other developed countries, according to the International Federation of Health Plans, a global network of health insurance industries. The most expensive hospitals charge more than $12,500 a day. And at many of them, including California Pacific Medical Center, emergency rooms are profit centers. That is why one of the simplest and oldest medical procedures — closing a wound with a needle and thread — typically leads to bills of at least $1,500 and often much more.

Medicynical Note: Read the article for the gory details.  But it is a fact that hospitals like other players in the health care game have little to no interest in fostering efficiency and cost savings–except to benefit their bottom line.  In regard to patient’s charges, their goal is to maximize them.  They inflate their charges to unimaginable levels then cut deals with high volume insurers.  Should you be uninsured they will  stick you with the full non-discounted amount.  To the little guy it’s as confusing as dealing with a used care dealer (no insult intended) and is nothing more than a legalized scam.  Horrifying as it is, that’s what’s become of my profession and American medicine. 

Health reform while not perfect is a start on rationalizing costs, providing universal coverage, and opening up the mystery of health care costs.

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