Underfunded and Overcrowded: Health Care Issues in America’s ERs
The United States health care system is a tangled mess. Health care workers have demanding jobs, whether they’re Emergency Medical Services, primary care physicians, nurses, pharmacists, or technicians in the operating room. But often the system itself is deeply flawed in ways that affect not only patient care, but also workers in the field.
These flaws extend to health insurance — one of the more talked about issues — as well as billing, funding, equipment, how costs are calculated and distributed, how treatments are dolled out, and how legal concerns and lawsuits affect protocols. As mentioned, health insurance has had the bulk of the attention in recent years, but other issues have come to light more clearly, following audits, tragedies, or political attention. The Department of Veteran Affairs has come under extreme heat after whistleblowers revealed the extent of wait-listing and the subsequent death of America’s military veterans who depend on that system, and even the badly underfunded and inefficient mental health services program has seen attention with shooting incidents last year.
However, one area of the health system that doesn’t always get the reform, funding, or attention it deserves, is the emergency room. The Milken Institute School of Public Health at George Washington University produced an in depth infographic illustrating how and why issues in service time and quality at the ER level arise. The MHA program put together information that “highlights the history of emergency medicine and the major causes of congested ERs,” while also considering “the impact overcrowding has on care delivery” and going into potential answers to some of these problems.
The graphic features an almost overwhelming wealth of information on where the health system is struggling and failing to sustain aspects of its emergency response system. According to an emailed release from Adam Levenson, community manager for MHA, the graphic answers everything from “what happens when an emergency room is faced with more patients than it can adequately provide care for,” to the negative impact of extended wait times, high costs, and overcrowding on “patients, providers, and administrators.”
“In the past two decades, the number of ERs has decreased by 25%,” writes Levenson. “Yet, the number of patient visits continues to climb. Increasing costs is one of the key reasons hospitals close ERs. Approximately $48 billion is spent each year on emergency services — 55% of which goes uncompensated.”
According to the Association of American Medical Colleges, this increasing medical demand on doctors and hospitals is largely explained by the aging population of America, which comes with major medical needs and a multitude of conditions. Yes, some of these conditions are chronic and require different forms of support and aid than are found in the ER, but others come on suddenly and result in emergency health care demands. As our demographics change, the need for care changes and increases as well. There’s also the fact that during any major health crisis, such as a disease outbreak or mass casualty incident, ERs, even working cooperatively, will be ill equipped to handle a major crisis, no matter the level of training and expertise among the staff. The AAMC joins many in offering suggestions for solving the shortage, including “team-based care and better use of technology to make care more effective and efficient,” but this once again collides with so much of the health care system’s problems.
If funding is already problematic, and current technology is too expensive, implementing the right changes becomes even more difficult. If ERs are currently “underfunded” and “increasingly challenged to do more with less,” as Levenson explains from the infographic, with patients being treated in the hallway, or sent elsewhere, it’s unlikely that any but teaching hospitals can afford to put new and improved technology forth. It’s not just a matter of understaffing, it’s also an issue of space — in 2010 there were approximately 130 million ER visits and 50% of ERs were at or over their limit.
One major criticism of Canada’s health care system is that while health care is affordable for all citizens, wait times are very long. This is listed among other arguments against universal health care in the United States, with Canada’s patient care problem given as evidence. However, it’s clear between the VA and ERs that the U.S. has its own wait time problems, partly a result of understaffing, and partly because of other inadequacies, and this is certainly the case in ERs where less severe cases must be dealt with first. According to Levenson, the average time between entrance and discharge is between 3 and 4.5 hours nationally, with some state times extending to 7.5 hours.
Follow Anthea Mitchell on Twitter @AntheaWSCS
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