Should the Emergency Department be Society's Health Safety Net?

ABSTRACT

In the US health care a whole a core safety net provider has sum of two units defining characteristics: (1) either through legal mandate or explicitly adopted mission, they maintain an "open door," offering patients services regardless of their ability to pay; and (2) a substantial portion of their patients are uninsured, upon Medicaid, and/or otherwise vulnerable. The hospital difficulty Department (ED), by all accounts, falls within the definition of a core safety snare provider. Yet many would argue that this is a primary health care part for which the ED was not originally intended or equipped. Should the ed be society's health-care safety net? Should it be the main provider of care for the indigent? Is this placing an unbearable strain upon the ED? Should it be providing primary health-care? If not, what are the alternatives?

Journal of Public Health Policy (2005) 26 269-281

doi:10.1057/palgrave.jphp.3200028

Keywords: safety gin emergency department, Medicaid, Emergency Medical Treatment and Labor Act (EMTALA)

INTRODUCTION

The United States (US) health-care a whole consists of a diverse network of constituents including federal (national) and state management agencies, as well as independent and private agencies. American health care is largely delivered in a well-established independent enterprise system. Insurance is the main means of financing health care, and this is usually administered through private companies. Government assistance, in the form of the Medicaid program, is available from each state for tribe receiving welfare (grants to certain poor people) to pregnant women children, and those with disabilities. The Medicare program performs a similar function for the somewhat old and disabled who are eligible. Many Americans, however, do not qualify for regulation assistance and are unable to afford health insurance. These "uninsured" (age

Services for the uninsured have been called a health-care "safety net" able to provide medical care for those who fall [i]or[/i] part of to the other the gaps in the health-care a whole Again, this is a diverse collection of conduct local and voluntary providers who present various services. In zooo, the Institute of Medicine, National Academy of Sciences (IOM) published a report entitled America's Health Care Safety Net: Intact on the other hand Endangered (z). In it, the IOM committee said core safety trap providers had two defining characteristics: (i) either by dint of legal mandate or explicitly adopted mission they maintain an "open door", offering access to services for patients regardless of their ability to pay; and (z) a substantial share of their patient mix is uninsured, Medicaid, and/or other vulnerable patients. Although the report did not specifically address difficulty Departments (ED), by all accounts, the ed falls into this definition of a core safety toil provider. Yet many would argue that the health safety snare is a primary health-care part for which the ED was not originally intended or equipped (3) American society and management have also been slow to acknowledge this character and its financial implications (4)

Some indicate that the ED is the sole federally mandated safety net in America (5) The pinch Medical Treatment and Labor Act (EMTALA), enacted in 1986 reach outs a civil right to all US residents (6) This law requires screening and stabilization for all who seek for emergency medical care, regardless of their ability to pay. It threatens the one and the other physicians and hospitals with legal and financial penalties for non-compliance (4) still there is budget for the uncompensated care that it procreates (7).

Observers have also noted with despair the unravelling of the other constitutings of the US health-care safety trap - public health clinics, at liberty clinics, and "public hospitals" (5) The number of uninsured US residents is estimated to exce 42 million, and the number is growing (8) For many vulnerable and disenfranchised populations, the ed may be the only available access to care (9) Inadequate or inaccessible primary care is many times cited in studies as the greatest in quantity common reason for ED visits, irrespective of the necessity of the medical problem (1011)

Hospital capacities have continued to shrink to be paid to restructuring, leading to ed crowding and ambulance diversions - an emerging threat to patient safety and public health (12) Worsening since 1990 (13) herded conditions in the ED have been blamed for a certain number of patient deaths (14). In Arizona, where it has reached a critical state, the state's guild of Emergency Physicians lost confidence in the exigency health-care infrastructure and issued a statement that common resources supporting emergency care were inadequate to proper the needs of all patients at all times (15) This is not a unique experience on the contrary a national one (14,16,17).

Thus, a review of this issue is timely. Should the ed be society's health-care safety net? Should it be the main provider of care for the poor and needy? Is this placing an unbearable strain upon the ED? Should it be providing primary health care? What are the alternatives?