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(Circulation. 2000;102:e9012.)
© 2000 American Heart Association, Inc.
Cardiovascular News |
Cardiovascular News
Sentinel Emergency Departments Report Safety Net Frayed by Uninsured and Managed Care
Across the nation, emergency physicians are sounding the alarm that the healthcare safety net’s holes are enlarged to a frightening extent, overburdening emergency medical services and hospital emergency departments to a near-breaking point. The reasons are complex, but they involve the nearly 45 million uninsured people across the nation and are compounded by the budget-cutting of managed care and the consolidations of the healthcare market place.
Emergency departments act as sentinels (healthcare canaries). A breakdown in the system of providing primary care can send millions of people into these havens of last medical resort. As emergency departments close, the burden on those left, particularly the ones in the inner cities, grows, resulting in long waiting times and crowded facilities.
California was hit first and hardest: 19 emergency departments in that state have closed since 1997, while visits have increased by 1.2 million. Ambulance diversions became so common in the state’s cities that they prompted the state to hold legislative hearings.
Michael Callaham, MD, chief of the division of emergency medicine
at the University of California at San Francisco, said his state’s
emergency system has been hard hit because of the cutbacks required by
managed care. In the first 4 months of the year 2000, he said,
hospitals in San Francisco diverted ambulances during 10% to 12% of
operating hours. Even in the summer, the hospitals continued to
call critical care diversions frequently. "You can’t have a lean,
mean system and expect to handle a flu epidemic, a disaster, or
anything