The Emergency Room: Urgent Care or Primary Care?”

By Ebony Tinsley A trip to the emergency room can be an expensive nightmare for households. It is a place that is often filled with frustrated patients and their relatives who feel vulnerable and neglected.  While the emergency room is designed for those who are suffering serious and unexpected medical conditions, there are more  non-urgent emergencies using these services every day. Forty percent of emergency patients were non-urgent in 2012. Moreover, the hospital emergency department is the only facet of the health care system required by federal law to provide care to all patients, regardless of ability to pay.  This means a clinician must prioritize patients, which contributes to the overall frustration in the emergency room. Many poor and working class people use the emergency room for primary care due to lack of education about medical care. Emergency medicine can be divided into roughly two broad areas:  pre-institutional care and institutional care.    Most people associate the institutional aspect with emergency departments.  However it also includes other areas such as urgent care facilities and specialized facilities like shock and trauma centers. Peter Nicks, an Emmy  award winning producer, released a documentary focused  on  the local county  hospital,  Highland  Hospital  in  Oakland.  The  documentary  focused primarily  on  healthcare  policy  and  uninsured  patients  who  often  wait  from one to  14  hours  for  care  in  a  room packed with  others waiting to be seen. This  Emergency  Department  overcrowding  strains  the  limited  resources  of hospitals  like  Highland. Debates about  who  uses  Emergency  Department  Resources  are  common  in  the medical  field  While  people  with  private  insurance  account  for  most emergency room  use, non-urgent  visits  account  for  10 percent;, most  of  which  are  paid  by  Medicaid. Non-elderly   adults  with  Medicaid  generally  have  higher  emergency  use  across  the  board.  Interestingly  enough,  the  primary  diagnoses  of  emergency patients  with  Medicaid  ages  21-64  were  digestive  diseases  and  urogenital  diseases. So what  is  causing  the  disparity  in  views  and  healthcare  among  Medicaid  patientsand  private  insurance  patients?  Urgent  patients  are  prioritized in two ways –whether  their  injury  is  internal  or  external  and  how  the  injury  occurred,  which  determines  treatment. If  judged to be  medical  (non-urgent),  the  clinician  searches  for  the  force  or  condition  responsible.  This type  of  assessment requires  quick  thinking. Fifty percent of  Medicaid  and  private  insurance  patients  were  categorized  as  urgent. The  problem,  however,  is  that  a  full  physical  exam  is  not  included  during  rapid  assessment.  Many  patients  have  the  potential  to  be categorized  incorrectly  as  a  result. The  Medicaid  program  solution  increases  patient  cost  sharing  to  discourage  patients  from  using  Emergency  services.  This  penalizes  Medicaid  patients who  use  Emergency Departments for  primary  care. Future work  should  focus  on  creating  access  to  adequate  healthcare  for  poor  and  working  class  communities. Facilities like  the  James  A  Watson  Wellness  Center  work  towards  this  goal  by  providing  primary  care  in  the  treatment  of  prevalent  diseases  such  as  hypertension,  cardiac  disease,  diabetes,  HIV,  and  cancer. The James  A.  Watson Center believes that access to preventative care programs must be available to not only the wealthy and affluent but also to the needy and underserved.
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