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Monday, January 22nd 2007

What Schwarzenegger's Plan Offers ERs

Another article on how the Governator’s plan will influence a specific part of the health care delivery puzzle. This LAT write up looks at illegal immigrants who receive care for chronic conditions through the emergency room.

About 40,000 people each year — about 22% of ER patients — go to the emergency room at County-USC with health problems that do not qualify as true emergencies, according to county officials. Millions of people across the country do the same thing, but the problem is especially acute in Los Angeles County, where a quarter of non-elderly adults are uninsured.

Partly to ease this strain, Gov. Arnold Schwarzenegger proposed earlier this month to ensure coverage of all legal residents of the state and illegal immigrant children. But even if his proposal passes, undocumented adults such as Hernandez would still have to depend on the county system.

Moreover, the governor proposes shifting $2 billion away from indigent healthcare — money that counties count on — to pay for universal health insurance, said Robert Ross, president of the California Endowment, a nonprofit foundation devoted to healthcare solutions for the poor.

The emergency room is not for this type of care. The patient profiled in the Los Angeles Times piece suffers from portal hypertension related to cirrhosis and comes into the ER every once and a while for paracentesis. It would obviously be cheaper, and improve his health if he had a clinic and PCP he could visit.

“Our goal is to identify the 5 to 10% of our population that is driving 50 to 60% of our [ER] costs,” said Pete Delgado, County-USC’s chief executive.

And then to

steer patients such as Hernandez into private clinics. There, they can be treated more regularly and inexpensively, and the visits cost eligible patients nothing but time.

The trial program has 100 patients currently.

Each of the 100 selected patients was assigned a private community clinic and a health coach. The clinic’s job was to attend to the patients’ needs, at taxpayers’ expense, whenever they showed up. The coaches’ job was to — in some cases literally — take patients by the hand and teach them about clinics.

Like I said, the article is largely an antecedal profile of a single patient, but it is a compelling experiment. I’m wondering what the capacity of these private clinics is. If they can handle the full load of patients who currently seek ER care for non-emergencies then I guess that contributor to ER overcrowding really is just a matter of the community not knowing their options.

Here where I am in Texas, with so many public clinics run by the county health system, you would question why anyone would come to University’s ER for a non-emergency except if they didn’t know. Not that the clinics don’t suffer overcrowding as well, but from my experience they seem to offer a better option.