how can we fix healthcare if ppl keep abusing the system?

KungFuFtr · Mar 9, 2010

Nobody called an ambulance over McDonald's speed of service. The police were called. It snarled up the 911 emergency system, but it didn't raise health insurance costs.
Calling 911 for what we consider to be minor complaints doesn't effect health insurance either. Dispatchers ask questions that assess and triage the callers' complaints and respond to the situation accordingly. I haven't seen an ambulance response for cold symptoms, ever, unless there was another medical problem also at play. I have seen it for "minor burns" because burns are judged by depth of tissue damage and extent of involvement. Age and overall physical condition also matter: for chemical and thermal burns, what's minor for people in their twenties and thirties is less minor for those in their fifties and sixties, and probably not at all minor for folks in their seventies and eighties or for little ones still in the single digits.

The OP was referring to a post that I made in which someone arrived via EMS for a pizza burn.

JessicRN · Mar 9, 2010

The abuse is rampant where I work and will never change 911 is a joke here. Ambulance cannot refuse anyone, we have people who are discharged from one hospital who walk across the street to came to another hospital only to walk out and do it a third time , we have pts who come in by ambulance with ear aches who when arrive get off the stretcher say thanks then leave as they needed to get to a store or an appt or to a restaurant and they are any age and an ambulance is cheaper then taxi. We have had one pt come to the ED 5 times a day every day for a month for several years we sectioned her only to have the courts let her go only to have her return again and again COPD we have had people come in every night with anxiety because they are lonely and need company. All call 911 many don't pay a dime as they are illegal and we are a safe haven for illegals. MY favorite is the "good samaritans" (they are people who do not like stepping over drunks"who call 911 because they saw a drunk stumbling in the square ( a popular watering hole) when the police arrive, they are given a choice jail or hospital, they always chose ambulance and hospital as they give you food and drink and warm blankets. If the person cannot walk we are the drunk tank so they come to us until they can walk. During the holidays the good samitans increase exponentially not to mention the police empty out a popular tourist spot every 4 hours for the tourists so we get about 4-5 drunks every 4 hours. We have about 15 a shift like that none have anything but gov't insurance if at all. Many of our doctors are new so they work these patients for "change in mental status (lab banana bag CT head etc all at least 5-$10000 workups) some get 2 CT's in a day. We also have a large group of drunks who use us as a shelter as they were kicked out of one because they were violent. All come by ambulance, all have chest pain. We have one pt who comes in everyday as a walkin with chest pain SOB for 10 years (if you refuse her she sues and wins she has won 3 times.) . 70% of our patients in our hospital is either illegal or indigent. They have a PCP but do not use them they are on medicaid medicare etc all gov't insurances. We are their PCP . We have a kind of universal insurance for the indigent or people who are not middle class and above but still they won't get it. The only people who do not use the ambulance service are the people who truly need it. Parents use our ED as clinics for there children and relatives as then they can come on their own time rather then take time off work for an appt many come by ambulance as they have no car many because there is a $2.00 copay to see a PCP and to come to the ED is free choose the ED. Many want precriptions for OTC meds as the government lets them buy it for $1.00 or free in many cases. The only people who do not abuse the ED are people with real insurances not government ones. The ambulance also abuses the system they bring patients from a chronic rehab for "stabalization" knowing that the patient belongs at a different hospital and will be transfered there. (it is funny trauma pts no matter how critical are never stabilezd here before going to a trauma one hospital even though we are a trauma 2 hospital. The longer I work here the more the abuse I see

I know in Canada it is sooooooo different as I lived there although it was awhile ago. You call 911 and they decide if they will send an ambulance. if it is not critical you are on your own ED waits are 8 hours and more so no one abuses it as they are so many CLSC (urgent care clinics run by the government) that are much faster. If it is deemed that your reason for coming to the ED is non urgent the triage nurse just keeps putting you at the bottom of the pile and no one cares about press ganey scores as there is no competition in hospitals they are mostly goverment owned. Patients who are admitted get directly admitted to a floor you do not have to go through the emergency dept for a complete workup first like here.

itsmejuli · Mar 9, 2010

I can't help but wonder how many posters have been in the situation of having no health insurance themselves. Or how many have had to deal with a loved one being an addict.

DaniGrrl · Mar 9, 2010

The really abusive side of the system is the amount of money that is dumped into it by people who are working hard and trying to get by and how little those same people get out of it. Please don't try to claim that that is due to abuse by the uninsured, have you seen the profit margins on insurance companies? The economy is in the toilet and they are turning record profits and dropping customers and raising rates. That's abuse.

Katie5 · Mar 9, 2010

i just read a post where a nurse said that many ppl abuse the ambulance system by calling for cold symptoms and minor burns. how will we ever fix healthcare is ppl keep abusing the system causing the costs to rise? remember in the news the lady called 911 because Mickey D's would not give her the chicken nuggets she ordered?? i personally don't want to pay for health insurance for ppl like this.

It depends on which side you're looking at it from- another could argue, that people abuse healthcare because it isn't fixed. Hmm..

latebloomer74, LPN · Mar 9, 2010

But isn't that still a government funded social program??
Anyway, it's been suggested that the government go into the business of supplying clean syringes and drugs for addicts in the interest of their health. But whenever it's brought up, tea partiers eyes roll back in their heads, and they start chanting "why should I support drug addicts" and "why should I pay for other peoples' health care and my own too," progressing from there to "why should the government have to pay for addicts" and "why should the government pay for health care," then they start murmuring about "socialism" and "get government out of my medicare" until they foam at the mouth and pull their hair out, then they start to shriek "God" this and "God" that, and "remember the golden rule" and "do unto others as you would have them do unto you," then emit a final unintelligible shriek before collapsing to the floor in a fit, then swoon. It's just plain difficult to talk to these people.

OMG, you are so funny!!!! LMAO!!!

Ok, in all seriousness. I just love insurance, know why? Say you went into the store and bought a pie for say $5, you try to go out of the store and they charge you 20% of $5 to be able to take the pie out of the store. Just like health insurance!!! I pay 100% of my premium every month but they only cover 80 %. How would they like if I paid 80% of my premium? I'm sure I'd get dropped like a hot potato. I don't know about other people but I have avoided going to the doctor because I knew I could not afford the copayment. It's sad. And this causes a ripple effect. Someone avoids going to the doctor because they couldn't afford the copayment, they come down with a serious disease of some sort, by the time they have serious symptoms and they finally see the doctor, they may be too far gone to help or have a limb amputated or need a colostomy or go into a coma or die. Get rid of the insurance companies, they're predators and have no conscience.

Not_A_Hat_Person, RN · Mar 10, 2010

I think calling for prior authorization should be mandatory for non emergency ER visits. I have to pay more out of pocket if I do so, why doesn't the same apply for Medicaid pts?

Do you really want people with chest pain, suspected strokes, or serious injuries trying to call their insurance provider to get permission to go to the ER?

RhiaRN75, RN · Mar 10, 2010

I've thought about this many times. I don't think we can fix it. I really do fear that it's going to continue on until we reach a point where the only recourse is a healthcare 'bailout'. That will not go well- but I don't see an alternative.

In my area, people call 911, EMS must respond. In all my years, the only exception to this rule has been due to severe weather conditions. EMS for toothache? My child has the 'flu'? 'Kidney stone' ala prick-the-finger? Sprained wrist? Yeast infection? I've seen that and more wheeled in by paramedics. I have also seen the opposite. Mama's having a stroke and weighs 300 pounds and is in the back seat of a teeny car- that's always fun. Classic MI w/ whopping tombstones who drove themselves- I see that as well.

People come to my ER quite frequently with huge bills they've never paid and don't intend to pay. I know, they tell me. All well a good for the small percent who are really sick and truly cannot afford it but that's rarely the case.

To answer one question- I've been without insurance. My child had medicaid when I was in school. I've had family members and friends struggle with addiction. I have been ten dollars ahead of homeless. To use any of those as an explaination for misuse and abuse of the system is just an excuse. To come to the ER to try to get your stash replenished in time for the weekend is just slack. One recovered addict in my ER said- "I don't get it. How do people survive? I worked so I could buy my drugs- how else could I have afforded them?"

You'll frequently hear ER nurses gripe about medicaid. It's not that we have a problem with the program. It's the people we see abuse it. Parents who drag their kids out in all weather, all times of the night, for a cold. Yes, they smoke. No, they don't have a thermometer or tylenol. Can they get some 'take home'? Yes, this has been going on for days. No, we didn't call the ped. They want juice, meds, snacks, diapers, formula, and they want it in less then an hour. They have gas coupons, food stamps, medicaid, subsidized housing, a new cell phone, utility assistance, a decent car and public transportation, smokes, and a new pair of Uggs. Who am I to judge? Well, I've seen your not-sick kid more then I see my mother and you still can't afford tylenol or a flipping thermometer. Yeah, the new iPhone is cool. This is daily. I know there are plenty who don't abuse the system, which is why I never see them in the ER.

Insurance needs overhauling. Big time. Medicaid might not. There are rules. If people would follow those rules it would work a lot better. If the local agencies would enforce those rules it would work a lot better. The ER can't- our hands are tied by EMTALA. Am I rude to them? No. I only wish they would return the favor. I am a professional. I love my job. I just worry that I won't have that job- how long can the hospital stay open under these condidtions?

Medic2RN, BSN, RN, EMT-P · Mar 10, 2010

Dispatchers ask questions that assess and triage the callers' complaints and respond to the situation accordingly. I haven't seen an ambulance response for cold symptoms, ever, unless there was another medical problem also at play.

You haven't worked in EMS then. In a perfect world, your assessment would be on target. The real life scenario would probably shock you.

PopeJane3rd · Mar 12, 2010

This is interesting.

Zookeeper3 · Mar 14, 2010

Do you really want people with chest pain, suspected strokes, or serious injuries trying to call their insurance provider to get permission to go to the ER?

When you have some ER experience and see the abuse, you'll understand a two minute screening will not cause adverse events. The millions and yes billions that could be saved is astounding. Spend 8 hours on a friday night watching triage in any inner city ER.... you may change your tune after you see the real world. :twocents:

allnurses Guide · Mar 14, 2010

I can't help but wonder how many posters have been in the situation of having no health insurance themselves. Or how many have had to deal with a loved one being an addict.

I don't have health insurance. My father died of alcoholism, acute and chronic, in an Emergency Deptartment at age 59. What JessicRN described is exactly the situation nurses in urban Emergency Departments face every day. I consider myself one-hundred percent unqualified to pass judgement on their compassion qualities until I've walked a mile or ten in their shoes.

I will say, that my dad, in the end stages of alcoholism, looking more like 79 than 59, may have appeared to the ED staff as just another homeless drunk, when in fact he was a trust-fund child who owned a beachside home that he allowed the homeless people he hung around with to flop at his house. He bought them meals. I have no idea how the staff taking care of him treated him that night. I wasn't there. But I do know that I was able to talk to a nurse on the phone later on who was there.

She said, "Oh, yeah! I remember your dad! None of us really knew why he went bad so quickly." Her tone was concerned and respectful. She then proceeded to talk to me for about 10 minutes, but it seemed like an hour, because she was my only connection to the last moments of my precious, sick Dad's life. The relief I felt after that really can't be described.

That nurse was my lifeline when I needed most to have it. At the same time, if she also came here and authored a blistering vent about the free-loaders, I would not be offended! Let's stop treating each other as one-dimensional beings who have a robo-response to each and every situation. I have the utmost respect for JessicRN and the others who accurately describe what they see every day. Likely they know that whatever reform is ultimately enacted, this group of people they serve is unlikely to change significantly. I'll leave it to them to explain why that is. I know for a fact it isn't because they are anything less than dedicated people who would want nothing more than to see them transform into healthy, happy people. Thanks for reading my story. :nurse: