Queues in the U.S. - for the uninsured
Uninsured adults face yearlong delays for some surgeries
By Mary Engel
Los Angeles Times
July 25, 2007
Adults with no health insurance face waits up to a year or longer for gallbladder or hernia surgery in Los Angeles County.
Community clinics rely on five county-owned hospitals to provide virtually all specialty care, including hernia and gallbladder surgery, for their uninsured patients.
With a quarter of the county’s adult population lacking insurance, patients have always had to wait a long time. But delays are growing longer as the population ages and suffers complications from such chronic conditions as diabetes and obesity.
More than a decade ago, the county partnered with nonprofit clinics to give the uninsured a place to go besides emergency rooms, which must see patients regardless of their ability to pay. Health officials also hoped that regular visits to primary care clinics would keep illnesses from getting worse and turning into real emergencies.
With funding help from the county, 43 nonprofit groups operate 117 community clinics throughout Los Angeles County. The clinics collectively see about 600,000 low-income patients a month for asthma and flu, diabetes and prenatal care, gynecological exams and immunizations.
But people without insurance also get hernias and gallstones, suffer failing hearts and ailing livers that, though not technically emergencies, are beyond the skills of the clinics’ primary care doctors, physician assistants and nurse practitioners.
(A table published with this article reveals that patients of the Southside Coalition of Community Health Centers have a typical wait time of six months to one year for most specialty services.)
http://www.latimes.com/news/local/la-me-wait25jul25,1,788861,full.story?coll=la-headlines-california
Comment:
By Don McCanne, MD
The opponents of reform frequently claim that a program of national health insurance would introduce queues into the United States. But they’re already here. As an example, for one quarter of the adult population in Los Angeles, excessive queues are already very much a fact of life.
What would happen if these individuals were covered by Medicare? Obviously they would receive their care in as timely a manner as is logistically possible, like the rest of us who are insured. They would not be limited to obtaining their care in over-crowded and under-funded community clinics and county-owned hospitals, a problem which would be somewhat alleviated by the infusion of Medicare funds that would pay for the care that is now delivered without compensation.
That does not mean that we can be inattentive to our health care infrastructure. Yesterday the Massachusetts Medical Society released a report in response to their state’s mandate for (pseudo-) universal coverage.
From the report:
“The inevitable increase in patient demand is occurring in the midst of an increasing physician shortage. Among the new specialties showing strain are family practice and internal medicine, two of the most important to providing adequate preventive care and minimizing the use of emergency departments. Newly insured residents may find it difficult to get timely appointments with physicians due to these shortages.”
What should be our response? Do we make appropriate capacity adjustments, introduce queue management techniques, and prioritize our health care spending so that everyone can have timely access to all reasonable care? Or do we abandon the concept of comprehensive insurance for everyone, and tell those without adequate funds that they’re just going to have to wait and see if they will ever be able to be seen?
Choosing the latter would perpetuate our uniquely American, anti-egalitarian stance. But isn’t that sort of Sicko?
Massachusetts Medical Society, “Physician Workforce study:”
http://www.massmed.org/Content/NavigationMenu/NewsandPublications/ResearchReportsStudies/PhysicianWorkforceStudy/2007Workforce_ExecSummary.pdf