Insurance status used in triage decisions
The Washington Post
April 26, 2004
Some Finding No Room at the ER
Screening Out Non-Urgent Cases Stirs Controversy
By Ceci Connolly
University of Colorado Hospital is leading the way on a controversial solution — weeding out the people with bumps and scrapes so it can devote more time and resources to serious, life-threatening traumas and, also, to paying customers.
Under the new policy, University hospital demands partial payment up front from non-emergency patients who seek treatment in the ER. For some, including Medicare and Medicaid beneficiaries, the fee is a small cash co-payment; insurance pays the rest. For the uninsured, however, the charge can be a few hundred dollars — money many don’t have. So they leave, toting a list of low-cost clinics in the area.
But the desire to redirect minor cases to more appropriate treatment facilities only goes so far. In a perversion of the system, insured patients are welcome to stay, no matter how trivial the problem.
Many in the community say they would not have an issue with triaging patients out of the ER if University could make them appointments at a more appropriate facility, as the city-funded Denver Health does.
“We do over-utilize our emergency rooms”, said Lorez Meinhold, executive director of the Colorado Consumer Health Initiative. “But a piece of paper listing local clinics is not access to care.”
“It’s an incredibly mean, nasty time to be in medicine”, said Mark Earnest, a general internist at University and vice president of the Colorado Coalition for the Medically Underserved. “There is not a consensus on how we are going to take care of people, and the result is everybody having to worry about their own survival”.
http://www.washingtonpost.com/wp-dyn/articles/A41995-2004Apr25.html
Comment: Triage is an absolutely essential, fundamental function of
emergency rooms. A properly functioning emergency room will have triage decisions based strictly on medical need, and it will provide an accessible pathway based on that need.
But when an individual’s insurance status becomes a part of the triage equation, we realize just how perverse our system of financing health care has become. Allowing insured patients to elect to receive unwarranted, excessive services is wasteful of our resources, while sending an uninsured patient away without adequate access to affordable care is an inequitable underutilization of these same resources. Equipping emergency rooms with a one-way back door to the alley is not an adequate solution for the uninsured.
If everyone had comprehensive insurance coverage, then triage decisions could be made strictly on the basis of medical need. With a rational system of financing care, we would certainly still have many challenges in our efforts to reform health care. But without a rational system of funding, we can’t even have dreams of moving closer to a health care Utopia.