Friday, January 30, 2009

Cure-all Clinics?

Interesting news out of Salt Lake City (how often do you hear that phrase?), where the Utah state senate is considering a proposal to build new clinics in an effort to divert non-emergent patients - 60% of visits according to one estimate - from overcrowded ERs.  

The concept of using clinics to help ease the burden isn't new, but it is interesting.  Several months ago, the Washington Post published an in-depth article about Michelle Obama's role in a program that attempted to dissuade patients from using the ER as a source of primary care and directing them to neighborhood clinics instead.  Politics aside, it seems like a great idea on paper: redirecting the non-critical to more appropriate settings while freeing up ER beds for those with life-threatening emergencies and saving millions in healthcare costs.  Critics, however, maintain that the program is merely a way for the University of Chicago Medical Center "to save money and reduce costs by serving fewer poor people without health insurance."  

It raises the question: what role should the ER play in our healthcare system?  Since EMTALA, emergency rooms have come to be seen as offering "free" care for anyone who walks through the door.  If a hospital attempts to redirect patients without insurance to local clinics, should they be seen as trying to provide more appropriate primary care or as dumping patients who can't pay?

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