Reader Response to ER is a Hit

Our recent "ER is a Hit With Insured Americans" news item stirred up some reader response. To give us your comments on this or any other B&H article, e-mail us at Rick.Service@medec.com. Please specify if you'd like your name withheld.

Here in Vermont we’ve seen the same trend found by the Center for Studying Health System Change, that ER use by the insured is climbing, and that the majority of cases are non-urgent. Examining data for one year (1999-2000) at our only tertiary care hospital in the state (Fletcher Allen Health Care), we found that ER visits started climbing every weekday around 4 p.m., peaked at 7 p.m. and then dropped off by 9 p.m. Most visits were for headache, otitis media, UTI, GI problems, etc.

All over the state our community hospitals are also seeing significant increases in ER visits, so much so that several have filed Certificate of Need applications that include ER expansion, a very expensive way to provide access to non-urgent, primary care in a rural state.

My theory, which I wish the Center or some other think tank would investigate, is that this shift coincides with, and in fact is related to, the anti-managed care "patient rights" movement that has eroded the ability of HMOs and other managed care organizations to require a call to the PCP or other triage prior to a visit to the ER. Here in Vermont we actually have a "patient rights" law that requires HMOs to permit self-referral. Sure, there is a "reasonable person" standard in the Vermont law, but what reasonable HMO wants to take on its subscribers in front of a regulatory review panel over whether Johnny's fever was high enough, or Alice's rash was life-threatening.

Hey, folks: the only way to spend less money on health care, is to spend less money on health care.

Jeanne Keller
Keller & Fuller, Inc.
Burlington, VT

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Reader Response to 'ER is a Hit '.

Business and Health

Dec. 10, 2003;21.