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Waste in Health Care Sector. Where Americans Get Acute Care: Increasingly, It’s Not At Their Doctor’s Office. Stephen R. Pitts1, Emily R. Carrier2, Eugene C. Rich3 and Arthur L. Kellermann4 http ://content.healthaffairs.org/cgi/content/abstract/29/9/1620

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where americans get acute care increasingly it s not at their doctor s office
Where Americans Get Acute Care: Increasingly, It’s Not At Their Doctor’s Office
  • Stephen R. Pitts1, Emily R. Carrier2, Eugene C. Rich3 and Arthur L. Kellermann4
  • http://content.healthaffairs.org/cgi/content/abstract/29/9/1620
  • Where Americans Get Acute Care: Increasingly, It’s Not At Their Doctor’s Office
  • More than half of the 354 million doctor visits made each year for acute medical care, like for fevers, stomachaches and coughs, are not with a patient’s primary physician
  • More than a quarter take place in hospital emergency rooms.

Can the new federal health care law: maintain access to primary care b? When an already inadequate and inefficient system takes on an expected 32 million newly insured customers?

  • Records of acute care visits from 2001 to 2004, the researchers concluded that 28 percent took place in emergency rooms, including almost all of the visits made on weekends and after office hours.
  • More than half of acute care visits made by patients without health insurance were to emergency rooms, which are required by federal law to screen any patient who arrives there and treat those deemed in serious jeopardy.
  • Not only does that pose a heavy workload and financial burden on hospitals, but it means that basic care is being provided in a needlessly expensive setting, often after long waits and with little access to follow-up treatment.

“The E.R. is frequently the only option. Too often, patients can’t get the care they need, when they need it, from their family doctor.”

  • The new federal law is expected to bolster primary care by increasing reimbursement for practitioners, luring students into the field with incentives, expanding community health centers and encouraging new models known as accountable care organizations and patient-centered medical homes.
  • “If primary care lags behind rising demand, patients will seek care elsewhere.”
national costs of the medical liability system
National Costs Of The Medical Liability System
  • Michelle M. Mello1, Amitabh Chandra2, Atul A. Gawande3 and David M. Studdert4
  • http://content.healthaffairs.org/cgi/content/abstract/29/9/1569
  • A separate study illuminates another source of waste in the health care system — medical liability and defensive medicine.
  • The paper estimates that the medical-liability system added $55.6 billion to the cost of American medicine in 2008, equal to 2.4 percent of total health spending.
  • More than 8 of every 10 of those dollars — $45.6 billion — was attributed to defensive medicine by physicians who order unnecessary tests and procedures to protect themselves from malpractice claims.

While the dollar amount is “not trivial,” the authors noted that the fraction of total health spending “is less than some imaginative estimates put forward in the health reform debate.”

  • Rigorous estimates of the costs (e.g. including payments to malpractice plaintiffs, defensive medicine, administrative costs like legal fees and lost time by clinicians ) have been scarce in the past.
  • Their own calculations “should be interpreted cautiously.”

The new health law did not make substantial changes to the medical liability system, despite Republican calls for restrictions on malpractice claims.

  • “Reforms that offer the prospect of reducing these costs have modest potential to exert downward pressure on overall health spending”
  • “Reforms to the health care delivery system, such as alterations to the fee-for-service reimbursement system and the incentives it provides for overuse, probably provide greater opportunities for savings.”