Saturday, December 6, 2008

Why supply emergency medical services?

Low reimbursement (lousy payor mix) combined with high costs (liability), means that more hospitals are closing ER's or building new hospitalis without them. Meanwhile the ER visits keep growing, so that remaining ER's serve more and more patients.


  1. Good question. The incentives clearly aren't there from the hospitals' point of view. I'm thinking a lot of that (the lousy payor mix) has to do with uninsured people going into the ER when its totally unnecessary. So how do you get those people to stop going to the ER?

  2. The federal government regulates the EDs see all comers, however, provides no guaranteed payment (EMTLA. Sounds like a good a reasonable plan until you realize that it is another tax on hospitals and providers. Furthermore, with no real immigration policy, EDs are flooded with tons of illegal immigrants (or uninvited guests for the more sensitive) who get emergency care for free. Does the provision pf free medical care make hospitals and provider immune from litigation in the advent of an adverse outcome? No. Therefore, when proving high risk emergency care to the unfunded, hospitals and providers have all risk and no benefit. Doesn't seem to fit the rational actor paradigm?!