More On That Alleged Best Health Care In The World genre: Little Red Ribbon-Hood

The Waiting Room

Those opposed to an overhaul of the U.S. health care system frequently tout it as the best health care in the world. However, while there are many positive aspects to our health care system, more and more deficiencies have begun to emerge and receive the attention they warrant. Following last weeks report that the U.S. ranks last in the number of preventable deaths, the time one has to wait before receiving emergency care continues to increase...leaving those in need of prompt attention at risk.

TUESDAY, Jan. 15 (HealthDay News) -- The last thing you want to hear in the emergency room when you've got crushing chest pain or can't breathe is that you have to wait before you can get treatment.

Unfortunately, in too many instances, that's exactly what's happening. In fact, new research found that waiting times in emergency rooms have increased by 36 percent for all patients, to an average of 30 minutes per patient. And the sickest sometimes have to wait the longest: As many as one-quarter of all heart attack patients had to wait 50 minutes or longer before seeing a doctor.

Study author Dr. Andrew Wilper, a fellow in general internal medicine at Harvard Medical School and an internist with the Cambridge Health Alliance, reports in the Jan. 15 online issue of Health Affairs that the increasing wait times are the result of a "perfect storm" that has occurred as emergency room visits are on the rise while many ERs are closing their doors.

These expanding wait time compounds the plight of those who lack health insurance and rely upon indigent emergency room care for their health care. Not only are preventable and treatable illnesses being ignored until they become medical emergencies; those arriving in the emergency room with them are at greater risk since they are having to wait longer periods of time to see a physician and receive the attention they need. Is it any wonder that the number of preventable deaths in the United States is on the rise?

"The real problem is that patients are backing up in the ER. If a patient is still in the ER six or even 12 hours later, it means that room, that nurse and that equipment just aren't available for the next patient that comes in the door," explained Dr. Art Kellermann, a spokesman for the American College of Emergency Physicians.

Kellermann said a good analogy to this situation would be if controllers at a busy airport started parking planes on the runways. "We'd think they'd lost their minds, but that's what hospital administrations are doing with ERs," said Kellermann. "We've taken the most time-critical portal of care and allowed it to become gridlocked."

For the current study, Wilper and his colleagues reviewed data from 1997 through 2004 and included 92,173 adult ER visits. Of those visits, almost 18,000 were thought to need immediate attention at the time of initial evaluation, and 987 had a diagnosed heart attack.

Not surprisingly, the wait to see an ER physician also increased during that time. In 1997, the average wait was 22 minutes. By 2004, the average wait was up to 30 minutes -- a 4.1 percent increase in wait time each year.

For heart attack patients, even a few minutes of delay in treatment can literally mean the difference between life and death. Yet, the average wait time for a heart attack patient increased from eight minutes to 20 minutes over the study period -- a 150 percent increase.

The study also found that blacks, Hispanics and women had to wait longer for care. Whites waited an average of 24 minutes, while blacks had to wait an average of 31 minutes and Hispanics had to wait 33 minutes on average. Wilper said it's possible that blacks and Hispanics might be more likely to visit hospitals that have longer wait times in general.

He said there needs to be an expansion of insurance coverage, modified management of inpatient and elective surgeries because so many ER beds have been lost, and an expansion of primary care that might help ease the overflow at the emergency room.

"This is an issue that cuts across insurance status," said Kellermann, who pointed out that even people with insurance are left waiting in ERs, because there just isn't enough space or enough resources.

The report also notes that several hundred emergency rooms have closed their doors. I suspect that the decline in hospitals offering emergency care adds to the problem and likely reflects the disincentive for hospitals to provide such care since it often involves patients who lack insurance or any real means to pay for the services rendered.

As the number of uninsured Americans increases, the problem will only exacerbate...a fact that ought to be recognized by all Americans since it also has and will impact the care provided to those who are insured. Reciting the president's meme that everyone in America has access to health care may be an accurate statement; but it is also an inarticulate assessment. As the number of uninsured expands, a tipping point is inevitable and those inclined to ignore as much are simply burying their heads in the sand.

Those who emphasize the waiting times for health care in other countries as a reason to oppose some form of universal health care seek to portray those delays as a justification for the U.S. market driven system. Unfortunately, that rationale only succeeds so long as 47 million uninsured Americans fail to receive preventative care and treatment for chronic illnesses and diseases. If those countries providing health care to all were able to ignore the routine health care needs of nearly 20% of their citizens, I suspect their wait times would decrease.

If America wants to assert its prowess in providing timely and top-notch health care, it must soon address the needs of the 47 million Americans who are being ignored. Our challenge shouldn't be to match the health care provided by other nations; it ought to be to actually provide the best health care in the all Americans...when they need it.

To do otherwise is an exercise in self-deception that will continue to be evidenced in additional negative reports. Wouldn't the verifiable pride that comes with a can-do attitude be preferable to false pride that results from a "don't look, don't see" mentality? Even worse, how can the deaths that result from foolish pride be anything but inexcusable?


1 On January 15, 2008 at 2:32 PM, Steven Mosher wrote —

Our health care has been struggling for years. Even with insurance, I still have thousands in bills from last year and this year.

Insurance is not the answer. Universal Health Care with a single payer is. I cannot conceive how something so fundamental in everyone's lives in the US is tied to a "for profit" system.

We don't have this with our police and fire protections. Yes, you can get insurance to cover for loss, and you can hire additional security, but the basic services provided for police and fire are essentially paid for when needed by anyone.

Thought Theater at Blogged

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