Do you think it will come to this?

258bourbon · Nov 11, 2003

Pamela--I often wonder what the state of health care will be in 20 yrs. My husband has been very ill over the last 3 years and for the first time I was on the other side. Thankfully this was before HIPPA because I had to spend soooo much time on the phone tracking down other peoples incompetence. He had a condition that was hard to dx and more difficult to rx. We had insurance and had to travel to various places to have lab work, treatments, etc according to where and what our insurance paid. I often felt that if he was on medicaid/-care it would have saved us alot of time and money.

I work in a rural hospital and about 80% of ER visits are things that I would go to my Dr. for. We have pts who have years of alcohol/tobacco use who are now ill and sit in the hospital for days w/ no insurance. They are unwilling to take responsibilty for themselves and think we should do it for them. I get really frustrated sometimes. I work 4- 12 hour days/wk (almost always understaffed, but that is another story :)) and manage 3 teenagers, a sick husband, house and a life. I can't even "qualify" for an aide to come into my home and help my husband bathe and get dressed unless we pay for it.

My husband and I have been in the workforce for over 20 years each and have worked professional jobs, paid taxes, had insurance-- What kind of return do we get?? I just get so frustrated at times, sometimes I wonder why I am trying so hard. We would get more assistance if we weren't working.

Jeeezzzz!! I sure unloaded on that one didn't I??

:eek:

hmccartn · Nov 14, 2003

Thanks for posting this thread. I am a 3rd yr nursing student in Canada, pondering moving to minneapolis a year or so after I graduate. I hope to learn more about your system in the next couple of years, so this helps. I think as Canadians we don't always realize how lucky we are to have health care accessible to all, regardless of income. If anyone has time can they explain to me what this HMO business is and how it differs from medicaid. Thanks. Hang in there.

flowerchild · Nov 15, 2003

Originally posted by Pamela_g_c
Patient presents to ER with minor symptoms, i.e. cough for several days, rash, excessive ear wax. Patient is asked if they have insurance, and if the answer is no or they are on medicaid, patient is refused service. Or maybe their name is flagged like it is in doctor's offices and when a patient presents with a non-lifethreatening complaint, that owes a certain amount of money, then they are told to pay something toward their bill before they will be seen this time.

Right now all the ER docs have to do is assess them for life threatening stuff and if there is none, then they can discharge them without so much as a script for tylenol. These patients are far and few between because it seems like in this day and age of litigation, more and more docs are afraid of missing something and being sued for malpractice.

I get so frustrated sometimes. Case in point: morbidly obese woman came in for a cough times 2 days. When I asked her if she had contacted her doctor, she said she didn't have any insurance so she had to come to ER. I wanted so badly to ask her how she was going to pay the ER bill if she didn't have insurance, but I restrained myself.

Sorry to vent, but just wondered if anyone else had any thoughts on this.

Pam:o

I get so agrivated by people who misuse the ER. I let my tongue fly the other day. The guy who trimmed our trees was telling me that his kids are on MCD. He tells me that they have OM, and how he took them to the ER for it. He tells me that he doesn't have a Dr. for the kids, just uses the ER when they get sick and why not MCD pays for all of it. I could fell my BP rising. I told him off but good. He's "slow" so I doubt it sunk in. Oh well. I tried! I told him "who do you think is paying for all this? Why don't you do us all a favor and stop abusing the system and get a primary Dr. to deal with non ER illnesses. His response, oh but everyone knows us and our kids so well down there and I get good care for my kids.

So essentially, it is the ER Docs and nurses who are advocating this behavior, at least with this family they are......but why????

rstewart · Nov 15, 2003

Hmccartm:

I thought I might take a stab at your HMO vs. Medicaid question. I am going to speak in generalities because there are some hybrids/variations, but here are the basic concepts:

An HMO (health maintainance organization) is a group of physicians and other health care providers who will provide health care to subscribers for a set fee. So a member/subscriber pays his/her monthly premiums and with relatively minor exception receives health care without having to worry about extra charges such as copayments, deductables, charges above reasonable and customary etc.. In the United States those extra charges can amount to thousands of dollars. But an HMO is one form of managed care, arguably the most rigid form; You can only use the physicians and other providers of the HMO. Further, your care is controlled by a gatekeeper physician. In general, you need that gatekeeper's permission to see specialists, obtain treatment, tests etc. That permission is not always forthcoming or it may be greatly delayed . So in its purist form, that is the tradeoff. Limited cost for limitations in provider choice and diagnostic/treatment options.

Medicaid, on the other hand is the individual state's health care program for the poor. If you have very limited income and assets, you may apply to receive your health care for free. It's welfare.

These days there is often overlap between HMOs and Medicaid; that is the very poor may apply to a state for free health care, but the care provided is in the form of an HMO.

Legislation, court cases and consumer preferences as well as rising costs have made pure HMOs less common. Certain limitations on who may be a provider have been eroded. The HMOs no longer have 100% say on what care will be provided to subscribers. More and larger fees (in addition to premiums) are being charged to subscribers. And some organizations offer at least some PPO like features.

But those are the basic differences. Hope that helped.

Jay Levan · Nov 15, 2003

I think you are missing a huge part of the equation here. I have been an E.R. Nurse for approximately 30 years, and have watched the ever increasing number of patients without health insurance. The part of the problem no one has mentioned yet is your elected officials that while making sure they vote themselves a yearly raise in salary and benefits that I believe includes totally FREE healthcare, while failing to protect its citizens health or the same people that elected them. I do not know if any of you are current as far as statistical information is concerned, but there are over 40,000,000 people without any healthcare plan at all and that number is expected to increase to 80,000,000 in a very short time. There are many of us in this profession that wind up without any healthcare plan after retiring, and many more of us who will be in the same boat shortly unless we put enough pressure on these politicians to pass a viable heathcare plan for retirees. Most of us will have worked the vast majoity of our lives, in a profession of helping those in need, only to become another of those statistics, while the politicians keep getting fatter. I wish you all fair better than many of our sisters and brothers. One more point, I think it is very interesting that a person who jumps over our fence into this country has immediate rights to healthcare while all the proceding information continues. Hope this information helps also.

oldiebutgoodie, RN · Nov 15, 2003

The problem is that health benefits in America stink. My neighbor, who is self employed, has to payover $1000 a month for health insurance, just to protect the family from something catastrophic.

The economy stinks, and corporations are laying people off in droves, as well as outsourcing their jobs to India, China, etc. So these folks don't have health insurance.

Those who are lucky enough to actually have a job still pay big time for health insurance, and their company is always trying to cut benefits even more.

As long as health benefits are tied to employment, and employers despise offering health benefits, more and more folks will end up at the ER.

National health insurance will probably happen in the next 10 years, because at some point, nobody will have private health insurance.

KaroSnowQueen, RN · Nov 15, 2003

My adult daughter has no insurance. She goes to the ER instead of the doc because:

a. The ER will diagnose her and give her a script for generic, cheaper meds because he knows she has no insurance. So the last time she went, she got two scripts that cost a total of $25.

b. The ER bill comes a month later, she can go to the finance office at the hospital and set up monthly payments for 3 or 6 months, at $30 to $50 a month.

c. The dr. wants $85 min. for an office visit, up front. If you're sick and missing work, $85 bucks is a lot of money for someone who is poor.

PLUS the doc doesn't always realize, even after you tell him!!, that you can't afford some new wonder drug that costs $110 bucks.

I know there are a lot of abusers out there, but this is why she does it. It really does make financial sense for her, at least in the short run. Cheaper meds, small spread out payments later on, and no big expense while ill.

epg_pei · Nov 15, 2003

Originally posted by KaroSnowQueen
...The dr. wants $85 min. for an office visit, up front. If you're sick and missing work, $85 bucks is a lot of money for someone who is poor...

It costs a non-insured student $27 to see the doctor at the student health clinic on my campus. That's not a subsidized rate either. It's the rate for patients who have no coverage whatsoever under Canadian Medicare ie international students. Makes you wonder.

Dragonnurse1, ASN, RN · Nov 15, 2003

Unfortunately I'm afraid that the day may come when there will be many towns and cities without any hospital at all. With the current payment formulas on medicaid and the amount of indigent care hospitals must provide to continue to qualify for MC/MD funds many hospitals are in a lose-lose situation. Mind you I'm not supporting my local hospital(former emp). Management (in some cases) is sucking the life out of the hospital while firing or "downsizing" in order to "meet budget". Most ER's in this country are loss-centers while most OR's are money makers.???

After 10 years in the same ER I knew so many of our "regulars" that I could fill out all their info, including allergies and meds without asking any questions. And many or these people had reg. MD's. When their MD was called and advised that the pt. was in the ER and their complaint and VS what did the MD say - Have the ER Doc see. Perhaps some of this could be reduced by requiring MD's to tend to their pts - even at 2AM.

Such a Kobiyasha Maru!!!!!

Nurse Shark · Nov 15, 2003

This is a very interesting topic...

I am a full time nursing student, I work part time, and my husband works full time with no benefits provided to him. Anyway we unfortuneately do not have any health insurance at all. We had insurance about 2 years ago but for a family of 3 here we were paying over $500 a month and every 3 months the insurance company would raise the rates. Also where I live every insurance company leaves and goes bankrupt and then your left trying to find new coverage. It was a no win situation.

Anyway when I am sick or my son is sick I still make an appointment to see my doctor and I pay the $75 at the time of the visit, but often times they will tell you they cannot see you for 3-4 weeeks but go to the ER.

About 1 year ago I had a severe migrane. I had numbness in my hands and feet, I was dizzy and vomiting, I had extremely blurred vision and after bing told that my primary doctor could not see me for 2 weeks I resorted to going to the ER. By the time I arrived my BP was 197/95 and I was in agony. The ER doc. ordered every test he could think of and even though I told him I had an CT scan 6 mo before he insisted. Anyway stupid me .... I now owe the hospital and doctor and lab about $3500. for a migrane. If I had insurance, my company would have been charged no more than $900 for all the services( the Miami Herald just did and article about the difference in charges for insured vs. noninsured a few mo. ago)

My point is sometimes people don't have much of a choice. If the government would come up with a solution to make health coverage more available and affordable than people would not be flocking to the ER for minor illness. Also if the government would set a limit on the amount a health care provider could be sued , then maybe malpractice insurance would be more affordable, and more doc. would carry it, thus less doctors would be so quick to order so many tests to cover their own azz. I don't know...

:confused: Sorry this is so long

tonchitoRN · Nov 15, 2003

i think most of the posters are missing the point. as long as people have no health insurance they will be using the er. try going to the md office w/ no insurance and you will turned away so fast (unless you have cash). a recent visit to the peds office for an ear infection was almost $200. the costs are outrageously high. something is going to have to give or else the whole health care system will collapse.