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Insurance Does Not Guarantee Access to Follow-Up Appointments

By Cedric Dark, MD, MPH, FACEP | on August 14, 2018 | 0 Comment
Policy Rx
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Insurance Does Not Guarantee Access to Follow-Up Appointments
ILLUSTRATION: Chris Whissen & shutterstock.com

We address a common misconception, even elicited by former President Barack Obama, that increasing health insurance coverage would ultimately reduce emergency department visits.

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ACEP Now: Vol 37 – No 08 – August 2018

Many Americans, even politicians, complain that people go to the emergency department unnecessarily. Perhaps it isn’t our fault as emergency physicians. It isn’t the fault of patients, either, for not knowing where is the “right” place to seek care. Instead, maybe we should look at the incentives our current system provides for the delivery of health care to better understand this phenomenon.

It continually amazes me that un- or under-insured patients must come to our public hospital, via the emergency department, for something as simple as orthopedic follow-up after being diagnosed elsewhere with a broken arm or leg—emergency departments being the only place beholden to EMTALA. We see them, take off their splint, and repeat the X-rays, then the orthopedics resident puts on a new splint and we schedule them for a clinic visit. It’s duplicative and inefficient.

I have even provided some curbside advice to a cashier at a restaurant regarding fracture care. She was wondering if she should return to the emergency department to get her splint converted into a cast because she couldn’t find an orthopedist to see her without insurance. Freed from the confines of the EMTALA mandate, I could openly discuss finances with her and explain the most cost-effective way of obtaining care. I instructed her to save up the cash for the orthopedic visit as opposed to coming back to the emergency department. Otherwise, she would have been responsible for an additional ED bill without getting the definitive orthopedic care she needed.

Our health care system is upside down. Americans believe no one should die or suffer irreparable harm during the moment of their emergency, but we offer next to nothing for prevention or follow-up care. The design of our health care financing system caters only to people with insurance or enough cash to satisfy the appetite of outpatient physicians. People in the margins of society, without significant financial resources, are lucky if they qualify for Medicaid.

Some policy wonks have argued Medicaid is worse than no insurance at all.1 While I don’t agree with that bleak assessment, especially because it does protect individuals and families from financial calamity in time of serious illness, Medicaid does appear to offer substandard options for care, as we see in the journal club article by Vidya Eswaran, MD, notably when it comes to obtaining specialist care.2,3

Pages: 1 2 | Single Page

Topics: Health InsuranceMedicaid

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About the Author

Cedric Dark, MD, MPH, FACEP

A graduate of Morehouse College, Cedric Dark, MD, MPH, FACEP earned his medical degree from New York University School of Medicine. He holds a master’s degree from the Mailman School of Public Health at Columbia University. He completed his residency training at George Washington University where he served as chief resident. Currently, Dr. Dark is an associate professor at the Henry J. N. Taub Department of Emergency Medicine at Baylor College of Medicine. Dr. Dark is the 2017 recipient of the Texas Medical Association’s C. Frank Webber Award, a 2019 American College of Emergency Physicians Choosing Wisely Champion, the Emergency Medicine Residents’ Association 2021 Joseph F. Waeckerle Alumni of the Year Award, one of emergency medicine’s Top 45 Under 45, and on Elemental’s List of 50 Experts to Trust in a Pandemic. He is currently on the Board of Directors for Doctors for America and the medical editor-in-chief for ACEP Now, the official voice of emergency medicine. .

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