After-Hours Health Care

by Virginia Postrel  •  Aug 24, 2008 at 7:06 pm

http://www.dynamist.com/2191/after-hours-health-care

Today's LAT features this amazingly unbalanced front-page story on a proposal--driven by California's state budget crisis--to increase premiums on the state's insurance program for poor kids. Sample sentences:

The state estimates that the parents of 19,000 children will end up dropping out of the program by July because of the $2 or $3 monthly increases. A family with three or more children, earning between two and 2 1/2 times the federal poverty level of $24,800 a year, would see the monthly premium rise to $51.

No, I did not omit the "from [current figure greater than zero]" at the end of that sentence. And, of course, it's written so you remember the $24,800, not the $56,800 to $62,000 to which the $51 actually applies. How many readers are going to do that math?

I'm not against providing a medical safety net for poor kids, but I am against blank checks, sloppy reporting, the misleading use of statistics, and unimaginative policy making. As it happens, just a few days ago I read this report from the Public Policy Institute of California on who uses emergency departments in California hospitals. (The big news is that, contrary to widespread belief, neither Latinos nor noncitizens are particularly heavy users.) The survey found that kids under 18 accounted for nearly a quarter of all emergency department visits, with about 40 percent of those visits paid for by Medi-Cal, the state's insurance program for the poor. Here's more:

Children covered by Medi-Cal have nearly 11 percent more avoidable emergency department visits than privately insured children and about 5 percent more than uninsured children. Nearly one-third of all emergency department visits by privately insured children are injury-related [i.e., actual emergencies--vp], considerably higher than for MediCal children--20 percent--and uninsured children--27 percent. Uninsured children, a relatively small group who constitute only 10 percent of children's visits, have much lower proportions of hospital admissions than children covered by Medi-Cal and by private insurance (1% compared to 6% and 4%, respectively).

The reasons so many kids end up in the emergency room aren't hard to understand. Emergency rooms are open 24 hours a day, so parents can go after work, and you don't have to wait for an appointment. That suggests that some serious cost savings might be possible, if only parents had a cheaper alternative.

One such alternative is beginning to develop: retail clinics in places like (gasp of horror!) Wal-Mart. And new research from the University of Michigan C.S. Mott Children's Hospital National Poll on Children's Health suggests these clinics fill exactly the needs that make emergency rooms so appealing for non-emergency visits:

Overall, 7 out of 10 parents who had used retail clinics for their children said they considered taking their children to the doctor's office. But 40% said they could not get an appointment at the doctor's office, and 46% said they wanted to take care of their children's problem more quickly.

The question for policy makers and social-service groups should be, How do you encourage parents to use such less expensive, more appropriate clinics? That might mean making it easier for clinics to open, or stay open after hours. It might mean educating parents about their availability or giving them some kind of incentive to use clinics rather than emergency rooms. It might mean teaching parents more about when kids really need to see a doctor. But it definitely means doing something more creative than complaining about budget cuts.