All is Not Fine with the Emergency Room Fine

I have to examine the numbers more carefully before commenting on the overall plan, but this part of Rhode Island’s new small business healthcare plan, as described by Felice J. Freyer in yesterday’s Projo, seems troubling…

You pay through the nose — $200 per visit — if you go to a hospital emergency room with a problem that does not lead to being admitted.
Obviously the state is trying to discourage people from using emergency rooms for non-emergency care — which may or may not be contributing to rising healthcare costs.
Yet at the same time, the state is also blocking alternative treatment facilities designed specifically for dealing with immediate but non-emergency care from opening in Rhode Island. Taken together, the policies seem to be designed to discourage people from seeking non-emergency care at all. I know that’s not the intent, but it’s the kind of stupid dysfunction you get when you try to manage individual human decision making through government planning.
And would anyone like to take a stab at explaining how charging people what is in essence a fine for using the emergency room helps to reduce costs? At first glance, the $200 surcharge seems more like a backdoor way to subsidize indigent care (those without insurance get still get emergency room treatment for free, right?) by grabbing money from families teetering on the edge of the middle class than it does a plan for real cost control.

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Michael Morse
17 years ago

I thought an emergency room was for emergencies. Broken bones, stitches that kind of thing. How often are you admitted to the hospital for a sprained arm? These co-pays are money grabs from people who can afford it the least. The “new” plan calls for free hospital care for people making under 200% of the federal poverty level. That number, whatever it is, is now the benchmark for the underachievers in this society. Some people know exactly how to exploit the generosity of our social programs and strive to get all they can. In some circles, that is considered smart and honorable.

17 years ago

How about we do something to try to deter people from using emergency rooms for things other than emergencies, and creating alternatives means of addressing them, especially those who aren’t even paying for the vist to begin with? I love it how we’re debating how much people who work hard and play by the rules will be hosed by the hospital, so that people who know how to “work the system” can get a provebial free lunch, dinner, and dessert on their back? I don’t think its a “backdoor way” to subsidize indigent care — I think it’s right at the front door, in the main lobby.
When I’ve had to go to the emergency room (which I’ve had to do on occassion due to certain chronic health issues), I’m absolutely sick (bad pun) of having to be “triaged,” stuck on a cart in the hallway or something, and because I’m not a gang member with a bullet or knife wound, having to wait for hours on end, because so many other people feel “entitled” to come in for a case of the sniffles they don’t feel like they should have to pay for.
The thing for the “charity care” for people 200% or under the poverty rate sounds all fine and dandy, until you realize that actions have consequences. When you give out something for “free,” without any effort to curb its use, people will use and abuse it. I’m sure it makes legisators with their gold-plated free healthcare benefits feel like they’ve done something to deserve their jobs. Except, at the same time, it ends up making an already bad situation a whole lot worse for ordinary people who really need to use the emergency room for true emergencies.

17 years ago

Yes, the state appears to be discouraging the use of emergency rooms by making it more expensive and encouraging them to use primary care facilities.
The real challnege is to get young males to enter the healthcare system. They are the best health risks, but often game the system. In most instances they don’t need healthcare, so they don’t buy insurance. Because younger males often do not have much income, they simply don’t their medical bills pay in the few instances when there is a catastrophic accident. It’s easier for a young male to play the odds and declare bankruptcy in the event he loses.
The result is that the healthiest group is not part of the risk pool, leading to higher rates for everyone else. It would be like removing the pool of married drivers between 25 and 65 from the auto insurance pool. If all you had were drivers under 25 and senior citizens, auto insurance rates would go through the roof.
This is a good attempt but I have concerns.
First, I don’t think the state forcing private insurance carriers to offer a certain policy is a good step. The key to success is more competition and less regulation, not more government regulation.
Second, the policy covers only 90% of hospital stays, meaning a person with a serious injury could still face heavy out-of-pocket expenses. When compared to existing policies that offer full coverage that charge only a slightly higher premium, I don’t think it does much.

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