One cannot avoid the healthcare reform debate going on in America today. Without a doubt, our healthcare delivery and payment system needs reform on multi-levels but it is important to deal with the facts and work to dispel misconceptions in healthcare.
One major misconception is that overcrowding in hospital emergency departments (ED) is due solely to the influx of the uninsured using the ED for basic medical needs. Actually, those with health coverage utilize EDs at about the same rate as the uninsured use EDs. In addition, it is an inaccurate generalization to suggest that the uninsured routinely use EDs for convenience.
While we are seeing more uninsured patients in our emergency rooms, they also are the sickest of the sick. This can be due to many factors: Health issues often arise “after hours” and sometimes even primary care physicians tell patients to seek treatment in an emergency room because of the availability of immediate testing or diagnostic equipment. It can sometimes be a challenge for the uninsured working poor or near poor to access basic medical care.
In addition, it is common for an uninsured patient to wait until a simple illness progresses in complexity until it is imperative to seek care in an ED. Often, the patient is so sick that he/she must be admitted to the hospital as an inpatient. Some of these patients are sick solely because they cannot afford their medications. For example, at Truman Medical Centers a majority of our patients have co-morbidities, meaning they have more than one disease. Many also suffer from mental illness. As a result, they may be prescribed multiple medications, which are difficult to purchase with limited resources. As a result, patients may choose what to fill, or take less than the prescribed dosage so that their prescription will last longer. In addition, because of limited resources, patients may ignore seeking appropriate follow up care after an ED visit.
It is crucial that any expanded health coverage include adequate prescription drug coverage, particularly for those who suffer from co-morbidities and because of health care disparities. This step, along with incentives to promote healthy lifestyles and wellness, would have a significant impact on health outcomes and on the cost of providing healthcare in this country.
In addition, it is imperative that any health reform strengthen and sustain the safety net. Truman Medical Centers provides one-third of the uncompensated care in the Kansas City area. We have learned from the Massachusetts experience that there will always be a need for a strong, vibrant safety net hospital system, and it is vital that health care reform allow TMC to continue to meet that need in Kansas City.
Mark Steele, MD
Chief Medical Officer
Truman Medical Centers
Kansas City, Mo
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