My patient went home the other day who had pulmonary fibrosis secondary to having raised pigeons and other farm related exposures. They are ranchers and very independant people without insurance. She told me how she did apply for government medical aid at one time. She said the place was filled with people who don't speak English, but she was denied help. No wonder people resent immigrants!
What she has been doing for years, she told me, was order animal supply antibiotics to treat her infections and illnesses. They are ranchers and raise cattle, horses, sheep so they have access to these things through their animal supply catalogues. They barely scrape by and obviously can't afford insurance. I heard from the doctor that they lost it at some point. Obviously, a lung transplant candidate isn't going to be viewed favorably by insurance companies.
I really loved this family. They were very appreciative and modest people, soft spoken and hard working gritty types. Yes, they own 100+ acres which has been in their family for more than one generation. The adult children follow the rodeos for a living. Should people like this be denied healthcare because they make their living from the land? Should they be forced to sell their land? Meanwhile, people who come into the country illegally get free medical care?
There's something wrong with our healthcare system where hardworking Americans are forced by financial neccessity to obtain antibiotics from livestock supply catalogues!!!:angryfire
Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.
You guys do realize that even under a crappy universal health care system or whatever you want to call it, illegal immigrants and people who abuse the ER's will still be around.
Illegals will still be around, but ER abuse will probably dramatically decrease. When I worked in the ED, some of the non-emergent cases we saw were people who couldn't afford or didn't want to pay the copay to see a primary MD. Others were the uninsured. Some UHC plans require patients to have a gatekeeper Doc for non-emergent care and referrals to specialists. Regular doctor visits increase, so chronic health issues are more regularly addressed. This leads to a lower amount of acute episodes in the chronic disease population, which also helps to decrease ED visits.
Illegals will still be around, but ER abuse will probably dramatically decrease. When I worked in the ED, some of the non-emergent cases we saw were people who couldn't afford or didn't want to pay the copay to see a primary MD. Others were the uninsured. Some UHC plans require patients to have a gatekeeper Doc for non-emergent care and referrals to specialists. Regular doctor visits increase, so chronic health issues are more regularly addressed. This leads to a lower amount of acute episodes in the chronic disease population, which also helps to decrease ED visits.
Precisely! My patient, for example, had been self medicating in a haphazard fashion, and had not been in to see her doctor in some time. Although very resourceful, this family is definately uneducated. I'm sure she was making inappropriate treatment choices for herself. She hadn't been in to see a pulmonologist in over 3 years. Now her disease has exacerbated into CHF and A-fib.
I'll bet the progression of her disease could have been slowed with better management.
Specializes in Spinal Cord injuries, Emergency+EMS.
Universal Health Care would SUCK. Don't do it.
and you're evidence base for that beyond the tabloids?
a system that sucks so much that 98% of people are seen and admitted / discharged from the ED in under 4 hours
a system where ED holds are so rare the Chief Executive and Region are informed if someone waits 12 hours for a bed
a system that sucks so much that you can get a primary care consultation within 48 hours at your own provider and much much quicker via the walk in centres or out of hours day service
a system that sucks so much that those referred for investigations in Acute coronary syndromes that doesn't require admission will be seen in under 14 days
a system that sucks so much that anyone with a problem which has a reasonable suspicion of beingcancer will be seen and assessed in under 14 days
a system which sucks so much that it;s target end to end for elective treatment is 18 weeks
Good Lord get hold of yourselves, do you really want the government in charge of EVERYONES health care? I sure don't.
You guys do realize that even under a crappy universal health care system or whatever you want to call it, illegal immigrants and people who abuse the ER's will still be around.
ED abuse will be much reduced - the UK has a far smaller ED abuse problem and we'd virtually eliminated it where i was working in the ED through partnership working with the Out of hours service - as most of our ED abuse was outside of normal working hours as people were too stupid to realise " your primary care provider and/or the Primary Care Trust has 24 hour a day 7 day a week responsibility for your primary care needs" - and spends a lot of money employing Doctors and Nurses to meet that obligation
Specializes in Happily semi-retired; excited for the whole whammy.
I never heard of using animal antibiotics before. I guess I really had my head buried in the sand on that one.
The reservations I have concerning universal healthcare center more around the quality of care than the financial costs. Given that family premiums for Pacific Care, our carrier, are over $600 for my employer, who have negotiated a pretty good rate because they have over 5000 employees, the raise in taxes that would be needed to pay for the program wouldn't likely cost as much as what the premiums cost. They would just be spread across everyone, including employers who now don't provide insurance benefits.
I understand why people object so strongly to undocumented immigrants qualifying for routine care when so many of the working poor don't, but if they are in fact getting anything other than emergency MA, there's fraud. That is what we should all rail against- not whether or not a given recipient speaks English.
Specializes in Spinal Cord injuries, Emergency+EMS.
I never heard of using animal antibiotics before. I guess I really had my head buried in the sand on that one.
The reservations I have concerning universal healthcare center more around the quality of care than the financial costs. Given that family premiums for Pacific Care, our carrier, are over $600 for my employer, who have negotiated a pretty good rate because they have over 5000 employees, the raise in taxes that would be needed to pay for the program wouldn't likely cost as much as what the premiums cost. They would just be spread across everyone, including employers who now don't provide insurance benefits.
the US health industry is 2 industries the actual provision of healthcare and a huge money go round attempting to bill for the minutiae of equipment and supplies used and chasing payment for this.
there is also the fact that all the way along there is elments of profit taken out , the broker, the insurer, the biller, the provider ...
if the broker, insurer and biller are the government out comes a significant saving , if billing moves from items of service to procedure based again comes another saving ...
providers can streamline their end of billing becasue of the majority of care provided they will be dealing with a single purchaser.
for someone like the community pharmacist it's so much easier (ok somewhat simplified) they tell a central clearing house how many prescriptions they've dispensed, how many were billed ( at one fixed prescription charge) and what drugs they've ordered the clearing house tells them a balance of the charges paid vs the Price paid for the meds by the system which is then forwarded ( ususaly from the clearing house to the pharmacist)
I understand why people object so strongly to undocumented immigrants qualifying for routine care when so many of the working poor don't, but if they are in fact getting anything other than emergency MA, there's fraud. That is what we should all rail against- not whether or not a given recipient speaks English.
the objection peiople have is that a so called civilised and 'free' (ha ha ha) country cannot even ensure that all of it's legal citizens have access to a decent standard of healthcare , if people wish to top -up cover and 'queue jump' for elective procedures then so be it , it's a market option that 's there in the UK ( and i would assume other countries)
I agree that our current system is broken and a disgrace.
What continues to surprise me, however, is the number of people including health professionals here at allnurses.com and elsewhere who can describe in great detail the shortcomings and outright idiocy of the rules and regs of the current government assistance programs ... but believe that a government-designed universal coverage program will be all shiny, bright and new.
JMO, but I think it's pure fantasy.
I do think that some form of universal health coverage is coming within 15 years or so, but I think it will result in an increase of what we are already seeing now and what exists in some other countries: a 2-tier or parallel system. Everyone gets rolled into the universal system, but those with the means to pay out-of-pocket get their care from private providers.
Interestingly, this tends to keep prices in line -- as in the significant drop in the price of Lasik and other similar vision-correction procedures in the last 5 years. This is almost never covered by insurance, so those patients are paying out of pocket for their procedures. When providers need to attract customers who will not be dipping into the vast well of insurance industry and/or government monies VOILA -- suddenly they find a way to keep costs in line. Go figure.
As for ER abuse -- there are several categories of ER abuse but from where I sit the biggest abusers are not those without other means of getting care but those who simply cannot differentiate wants from needs, no matter how much education you provide re: what constitutes an emergency. Patient A has insurance with a $20 PCP copay and a $75 ED copay. Patient A has had XYZ symptom for 3 weeks, then calls PCP office at 4pm on a Friday. Patient A becomes irate when phone triage nurse at PCP's office suggests appointment the following Tuesday and comes to the ER instead. And loudly makes known how pissed off she is by the expectation that she pay her copay. No matter what "system" is in place it will always be circumvented by those who simply want what they want when they want it.
Specializes in Spinal Cord injuries, Emergency+EMS.
I agree that our current system is broken and a disgrace.
What continues to surprise me, however, is the number of people including health professionals here at allnurses.com and elsewhere who can describe in great detail the shortcomings and outright idiocy of the rules and regs of the current government assistance programs ... but believe that a government-designed universal coverage program will be all shiny, bright and new.
from thje point of acute and emergency care - a universal system is great no worrying about who is going to pay and what for - the patient gets wheat they need clinically...
a universal system through it's economies of scale can also have a moderating effect on 'million dollar workups' where investigatiosnare done becasue they can be and because they might show something up - have a look at the NICE guidelines on head injury management, the guidance for CTscans is based on work fro mwither the US or canada to reduce the number of head CTs ( with assocated irradation) being undertaken - interestingly in the UK it increased the number of scans being done and substantially increased the number of out of hours scans being done ... for what benefit we aren't quite sure...
yes it'll upset some specialities when every one falls over and bumps their head doesn't get a CT ( but what are we storing up forthe future by irradiating as much as some systems do) or when they don't take a 'hancock' of blood from every patient in the ED ... but ultimately if a good evidence base is used to write these kinds of guidelines it reduces costs and increases access for those who really need investigations and interventions
JMO, but I think it's pure fantasy.
I do think that some form of universal health coverage is coming within 15 years or so, but I think it will result in an increase of what we are already seeing now and what exists in some other countries: a 2-tier or parallel system. Everyone gets rolled into the universal system, but those with the means to pay out-of-pocket get their care from private providers.
generally to queue jump for elective procedures or diagnostics unless mega rich
Interestingly, this tends to keep prices in line -- as in the significant drop in the price of Lasik and other similar vision-correction procedures in the last 5 years. This is almost never covered by insurance, so those patients are paying out of pocket for their procedures. When providers need to attract customers who will not be dipping into the vast well of insurance industry and/or government monies VOILA -- suddenly they find a way to keep costs in line. Go figure.
exactly, while insurance is paying people don't question costs, just moan about rising premiums when peopel are paying from their own pocket or via the tax dollar peopel will ask questions
As for ER abuse -- there are several categories of ER abuse but from where I sit the biggest abusers are not those without other means of getting care but those who simply cannot differentiate wants from needs, no matter how much education you provide re: what constitutes an emergency. Patient A has insurance with a $20 PCP copay and a $75 ED copay. Patient A has had XYZ symptom for 3 weeks, then calls PCP office at 4pm on a Friday. Patient A becomes irate when phone triage nurse at PCP's office suggests appointment the following Tuesday and comes to the ER instead. And loudly makes known how pissed off she is by the expectation that she pay her copay. No matter what "system" is in place it will always be circumvented by those who simply want what they want when they want it.
which is where the economies of scale from a universal system can be beneficial to provide an out of hours primary care service rather than it falling back on the ED
I want to know why the very same medications and dosages are available for so much less than for humans. Unethical pharmaceutical companies gouging their consumers is what I think. I think the same thigs gos for medical equipment companies. I just got a bill from my medical supplier for a nebulizer for my daughter for 211$. (My insurance covered 20$.) There is no way that the technology involved in this machine justifies this price. Market forces may indeed affect ipods and computers prices falling, but these companies recognize that their consumers need their products so therefore will pay for them, however artificially inflated.
ZippyGBR I appreciate your posts with your view from an outside-the-US perspective.
I probably agree with we in the US drive up costs with unnecessary diagnostics and procedures.
I'm not sure what the answer is. My personal observation is that most Americans are just astounded when they're sick -- it must be the fault of someone/something.
I'm also not entirely convinced that a universal system controls costs better while "people get what they need clinically." Perhaps. But even if there's no immediate "worrying about who is going to pay for what" ... ultimately someone pays. Or everyone pays.
I'm also curious about the NHS after-hours clinics you mention. How are they staffed? What resources do they have - lab, x-ray? Here in the US we have an increasing number of new retail-based walk in clinics staffed by nurse practitioners but they are unable to do lab work or radiology studies ... my suspicion is they end up handing out a lot of unnecessary antibiotics for people with garden-variety viruses which are making them feel ill.
To get an MD to staff an after-hours clinic here would be a hard sell, unless the clinic had lab and radiology. Otherwise, the perception would be that all you would do would be to sit through a weekend of listening to people whine.
Thanks for the input. Your mention of irradiating everyone and drawing a "hancock" of blood from everyone in the ED made me chuckle. What's a hancock, BTW?
Specializes in Spinal Cord injuries, Emergency+EMS.
equipment is a reflection of market size , a lot of medical equipment has a world wide market of afew hundred thousand to a few million units across all the manufacturers... somethign like an ipod or a mobile phone will sell a couple of million a year in most 'developed world' countries...
the testing and certification costs are probably the same but per unit are an order of magnitude greater
Specializes in Spinal Cord injuries, Emergency+EMS.
ZippyGBR I appreciate your posts with your view from an outside-the-US perspective.
I probably agree with we in the US drive up costs with unnecessary diagnostics and procedures.
I'm not sure what the answer is. My personal observation is that most Americans are just astounded when they're sick -- it must be the fault of someone/something.
I'm also not entirely convinced that a universal system controls costs better while "people get what they need clinically." Perhaps. But even if there's no immediate "worrying about who is going to pay for what" ... ultimately someone pays. Or everyone pays.
it has to be paid for , but there is no worry aobut 'messing up' and ordering an investigation that won't be covered - either it's clinically justified or it isn't ...
I'm also curious about the NHS after-hours clinics you mention. How are they staffed? What resources do they have - lab, x-ray?
out of hours primary care have the same access to lab and radiology as in hours services do - generally they refer to acute services ... it's primary care - if you need inpatient assessment you are sent for inpatient assessment - but directly to an assessment unit not via the ED...
walk in centres generally have access to X ray either via referral to the ED for immaging and then either eadvanced practce radiographers dicharge or the patient is referred to the ED
some W-I-Cs are streams within the emergency care services of acute hospitalsand peopel move seamlessly between streams if necessary,
Here in the US we have an increasing number of new retail-based walk in clinics staffed by nurse practitioners but they are unable to do lab work or radiology studies ... my suspicion is they end up handing out a lot of unnecessary antibiotics for people with garden-variety viruses which are making them feel ill.
well their clinical diagnosis and assesment skills need polishing - good primary care providers whether MD or NP can determine betwene probably a virusand probably an infection that needs ABx clinically ...
To get an MD to staff an after-hours clinic here would be a hard sell, unless the clinic had lab and radiology. Otherwise, the perception would be that all you would do would be to sit through a weekend of listening to people whine.
which is why out of hours primary care uses telephone and /or face to face traige to select patients who need an out of hours primary care physician consultation ... referring those who clearly need emergnecy hospital treatment to the emergency ambulance service or the ED and those who need basic self care advice are given the advice by the triage practitioner (usually an RN but in some settings a Paramedic (uk paramedics are health professionals not certified staff) there are also services which use Advanced practice Nurses and Paramedics
Thanks for the input. Your mention of irradiating everyone and drawing a "hancock" of blood from everyone in the ED made me chuckle. What's a hancock, BTW?
tony hancock 's 'the blood donor' sketch - "a pint that's nearly an armful " - a hancock - is therefore 'an armful' of blood ... ( FBC/CBC , biochem, cross match, clotting, glucose, ESR ....)
in temrs of irraditating everyone the impression i get is that the instinctive reaction of some US providers is the reach for the CT request form for any thing , bump on the head, belly pain ...
BBFRN, BSN, PhD
3,779 Posts
Illegals will still be around, but ER abuse will probably dramatically decrease. When I worked in the ED, some of the non-emergent cases we saw were people who couldn't afford or didn't want to pay the copay to see a primary MD. Others were the uninsured. Some UHC plans require patients to have a gatekeeper Doc for non-emergent care and referrals to specialists. Regular doctor visits increase, so chronic health issues are more regularly addressed. This leads to a lower amount of acute episodes in the chronic disease population, which also helps to decrease ED visits.