After-Hours Health Care
by Virginia Postrel • Aug 24, 2008 at 7:06 pm
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:
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:
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:
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.
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