Comments on: Incentivized Behavior

By: symtym

symtym — Sun, 04 Jun 2006 21:06:51 +0000

Incentivized Behavior To answer the question ("Hey you in the ER! Is this really an emergency?"—of course not! Historically the utilization of the "ER&...

By: lexi

lexi — Sun, 04 Jun 2006 00:25:55 +0000

For a different perspective on Medi-Cal:

My son has been on Medi-Cal since he was 3 months old. He’s now 4 1/2. He’s a double-transplant recipient (liver/small bowel), and we’ve never had a problem getting care for him at any ED we’ve gone to or at his pediatrician’s. Then again, we only ever hit the ED when something is Really Wrong, like possible line sepsis or a rejection episode.

I absolutely hate the invasive questionnaire I have to fill out every year to renew the Medi-Cal–how much money do you have at home? how many uncashed checks? how much do you have in the bank? how many cars do you have? how many people live in your home?–but, there’s no way I could afford to take care of my munchkin without it.

There’s also no way I can see to get off Medi-Cal now that my son is on it. Taking care of my son is my full-time job. My husband is employed, but his job only covers health insurance for him, not any dependents. I haven’t had health insurance since my son was born–I pay out of pocket for yearly checkups and all prescriptions for myself. Even if we did get me some cheapie health insurance, no one would insure my son–it’s a preexisting condition, and a very expensive one at that.

It’s a very frustrating situation, and though I can’t stand having my son on Medi-Cal, he would never have survived this long without it. –lexi

By: symtym

symtym — Sat, 03 Jun 2006 17:09:15 +0000

“Victims?” Perhaps at some level, but we got exactly what we incentivized. Field of Dreams: if we build it they will come. If we create a specialty whose livelihood depends upon volume–they will come. If we ratchet down primary care providers and venues (by upping competition and “productivity” via managed care)–they will come. If we, for 40+ years, inculcate themes of dependency, entitlement, immediacy, etc.–they will come. Like so many endeavors, we have been caught by the law of unintended consequences.

By: Bad Shift

Bad Shift — Sat, 03 Jun 2006 16:38:47 +0000

So, we are victims of our own sucess?

By: Carrie (NeoNurseChic)

Carrie (NeoNurseChic) — Sat, 03 Jun 2006 01:09:35 +0000

When I worked in the ED, we referred countless people to the health districts, aka free clinics. Going to the PCP costs money (or at least used to) on any of the 3 PA medicaid insurance plans, but going to the ER is free. Guess what that leads to? Overuse and abuse of the ER. On any given day, it seemed like about 1% of patients actually needed to be in the ER. Many more needed to see a doctor of some sort, but not necessarily in the ER.

My own views and biases on this became stronger by working in an urban trauma center. Then one night, I ended up there with a massive nosebleed that cost me a litre of blood in an hour. A friend of mine was surveying patients on their reason for going to the ER, if they had contacted their physician first, if they would have contacted their physician had they been able to (via emergency line, etc), and what they would rate their emergency on a scale of 1-10. Me, being the ever biased ED employee that I was, said…”Well I didn’t contact my ENT, and I guess I’d only rate this a 7?” My friend said, “Shut up. It’s a 10.” I ended up in surgery by the afternoon. Heh… I do have to seriously examine my rationale if I need to go to the ER, however, and it’s almost led me NOT to go to the ER when I should have.

Therefore, I had to raise my eyebrows the other day when one of my baby’s parents told me she was going to the ER for antibiotics. She seemed fine. Why not call her regular physician? In fact, when she returned to the unit, she asked me for the number to family med so she could call them and let them know she’d gone to the ER. Oy vey…

I did some time out at one of the busiest health districts in the city. It was…interesting… In many cases, the waits were just as long or longer than ER visits. A light turned on. Later, a good friend of mine, who is a social worker in the ED I worked at, asked me about the health districts since we so often direct people to go there instead of coming to the ED for common problems. I suspect the real reason people come to the ER is that they see they can get a wider variety and more in depth (almost left that as in debt..haha) type of care by going to the ER. Still doesn’t cut it as an answer, however!

And around here – a friend of mine refers to the ambulance as the “horizontal taxicab.” ;)

Take care!
Carrie :)