Delayed care often means denied care…

With all the talk about reducing the crowding of California’s emergency rooms, the conversation often goes toward placing financial and other barriers on patients, to make us “self-triage” our health conditions. The philosophy seems to be: blame the victim, burden the patient.

But there are far better remedies.

Our Governor and legislative leaders are right to suggest this is one of the many reasons why we all have an interest in covering the uninsured. While the uninsured are *less* likely to go to the emergency room (they are uninsured, and thus get billed full price), when they go they are *more* likely to be in worse condition, and a situation that could possibly have been prevented has now become more expensive.

But the bulk of ER visits are from the *insured*. And there’s a portion of ER visits by the insured that happen because the patient simply can’t get into see a doctor in a timely manner, and simply can’t wait for an appointment. So they end up going to sit out the wait in the emergency room, even though a doctor’s office would be a better (and cheaper) place to get care.

Even if you have insurance, have you had the experience that you can’t get your doctor’s office on the phone? Can’t get an urgent care appointment within a few hours or days? Can’t get a specialist for a couple of months? These are all reasons why people end up going to the emergency room when they should be seen far less expensively in a doctor’s office.

And no consumer should be expected to self-triage. Consumers are not health professionals: they do not have the training of a doctor or a nurse. Is a kid with 101 temperature an emergency or the kid that just threw up for 30 minutes? If stomach pain wakes you up in the middle of the night, should you be seen that day or can it wait? The reason people have health insurance is so that they can trust that a doctor or a nurse will answer these questions, not a new parent, a worried spouse, or worse yet, you by yourself when you are sick.

New regulations can help fix this, both so that those with coverage get the care they need *when* they need it, but also to help relieve problems throughout the system, like ER overcrowding.

At the newly redesigned website of the Department of Managed Health Care(DMHC), there’s a notice on new hearings and draft regulations to implement AB2179(Cohn) c.797 of 2002, a bill sponsored by Health Access California to ensure patients have *timely* access to care. The hearing notice is here: http://www.dmhc.ca.gov/library/reports/news/aron.pdf

Health Access has waited five long years for these regulations-but patients wait for care every day when they should not. It’s time to get these regulations done and time to redeem the promise that was made in 1975 when HMOs were licensed in California: the promise that networks of care would mean that people get health care when they need it, instead of being forced into emergency rooms for care that can better be provided in a doctor’s office.

We’ll be watching this one closely-and continuing to advocate for consumers.
Health Access California promotes quality, affordable health care for all Californians.

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