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Healthcare iconsOne of the topics I wrote about in Health Attitude was about access and equity of healthcare in America. The access part is about the fact 30+ million people have no health insurance. The equity part is about the fact millions of people not having health insurance is not fair. In a prior posting I said 40-50 thousand people per year die because they have no insurance. Just because they have no insurance. Academic studies have confirmed the numbers. The question is: how can this happen?

Federal law prohibits hospitals from turning away a person presenting him or herself to the ER. The law requires the hospital to evaluate the condition and stabilize the patient before he or she is discharged. If the condition of the patient makes it clear that his or her condition is acute, most hospitals will take whatever actions are needed to treat the patient until they are stable enough to be discharged. This happens even if treatment requires surgery or expensive drugs and even it the patient has no insurance or money. The problem is the exact condition of a patient and the determination of what is needed before he or she can be discharged is not always clear. Even Medicare will not pay a hospital to admit a patient and apply a battery of tests just in case there is something more serious than determined in the ER.

The point is emergency care is not comprehensive and does not provide preventive care. Some patients with serious conditions such as cancer, hepatitis C, HIV/Aids, or psychiatric problems often do not present themselves to the ER until the condition is advanced, in some cases reaching an incurable state. The ER may refer a patient to a physician who treats patients without insurance or to a clinic. Access to such services requires awareness and an ability to understand and engage healthcare services. Unfortunately, many uninsured are unable to navigate our healthcare system. As the wealthiest country in the world, this should not be so. The fraud, waste, inefficiency, unnecessary tests and procedures, and the runaway pricing of drugs represent two to three times the spending that would be needed to care for the uninsured. Read more about the access and equity in our healthcare system in Health Attitude.

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