The greatest trick healthcare companies have pulled is convincing Americans that after hours visits for things like high fevers and broken bones isn't basic care.

I'm 40, and my Mom was telling me about how my brother cut his head as a child, and the local small town doctor came in after hours to stitch it up. Different era.

Yeah, it's relatively low-probability but still essential. Getting a broken bone fixed seems like more of a basic human right than a "premium service".

That’s what urgent care is for. You shouldn’t be going to the ER for a typical fever or a cut requiring stitches.

What do you do when they’re closed? Guess how many urgent cares within 15 miles of where I live are open at 3:30 AM? I live in a major metro area, and the answer is ZERO.

We have some 24 hr ones here, but yes, if it’s not an emergency, but you need immediate attention, the ER might be your only option.

You don't need an ER for any of those things. We already solved this problem with Urgent Care.

Where I am, urgent care closes at 8PM and only takes two of the several insurance providers that are common.

ER is open 24/7 and doesn't turn people away even if they don't accept their insurance plan.

It is a basic visit. I attended a first-aid training for new parents here in my home country and the general advice was to seek help if in doubt, at night times by calling an ambulance or visiting, well, the emergency room.

In two years we were there with our baby two times. Not charged a penny. During this time, I went once, my wife went once. In all instances we were reassured that it was appropriate to visit the hospital instead of visiting the GP the next day.

Yeah, taking a kid with a high fever to the ER in Toronto is a total no-brainer since it's 100% covered by OHIP. Now living in SF, and I've found myself mentally doing risk probability calculations, and concluding I'd be better off skipping the ER and instead following the instructions from off-the-shelf motrin because the ER visit is likely not worth the cost.

My wife firmly believes the US healthcare system is a giant scam where insurance companies leech off people without actually providing any value.

> My wife firmly believes the US healthcare system is a giant scam where insurance companies leech off people without actually providing any value.

Health insurance in the US is built around providing value to employers. Most employers are concerned about which network is going to upset the fewest key employees and cost the least amount of money for the employer, while fulfilling all legal obligations, without making the employees spend too much time dealing with the insurance company when they could be working. Nicer employers may want to cover more of the cost, or want to upset fewer employees, or have specific things they want covered that aren't legally obligated.

There's also the problem that different groups of people want totally different things from the system. I like integrated care, because it provides me with a single place to go, that handles everything, even though it may not always be the best care. Other people are more focused on getting the best care, and are ok with (or prefer) to pick the individuals who provide each service, even though it means visiting multiple locations. Nicer employers offer you a choice of providers, but it would probably be less expensive for them if everyone was on one plan, at the cost of upsetting more employees.

It wasn't worth the cost in Toronto, either, but you didn't care because it wasn't you who paid the cost.

Technically I did, since my taxes pay for it. What I didn't pay for is the overhead of clerical work from two different corporations for mailing me letters informing me of how arbitrarily priced my doctor visit was.

You did pay for it. Half of the Ontario budget goes towards it.

The fact that you would go without thought of the cost but in a similiar situation would avoid because of the direct costs shows why the Ontario system is a poor model. The costs are hidden so more services are used. If costs were direct paid for out of your Ontario fund (a yearly budget that if not used would be carried forwarded or removed from your taxes) than a better balance could be found.

My taxes pay for the doctor's time, the nurse's time, the receptionist's time, etc. And that is entirely fair. It does not pay for clerical workers in different companies to be sending paperwork back and forth to satisfy some systematically complicated pricing structure, because such a thing does not exist. And it certainly does not pay the salary for the CEO of CollectiveHealth or whatever your provider is.

> The fact that you would go without thought of the cost but in a similar situation would avoid because of the direct costs shows why the Ontario system is a poor model

The pricing is hidden from me regardless, except that in one case people get the care they need and go on with their lives, and in the other I hear stories of people getting a surprise 4-digit bill in the mail three weeks later, after already paying through the nose for insurance.

When you look at international rankings of standard of living, the Ontario system is considered a good model (along with other similar healthcare systems such as those in nordic countries). The US model is poorer on several fronts, from pricing opaqueness to availability for low income people, and let's not even go into medical bankruptcies...

> and in the other I hear stories of people getting a surprise 4-digit bill in the mail three weeks later, after already paying through the nose for insurance.

Lol. I wish. For me it was 5 digits. Closer to 6 than 4. And I had a $1,800/month premium for a family of 4. Spent multiple hours per week for months on end playing phone tag for the hospital and insurance company until it got resolved. Hospital billing also told me to not worry because nothing ever gets paid until both sides start suing eachother.

Yeah, this is peak efficiency. I just love taking up "resolving medical bills" as an unpaid part time job for the better part of a year.

Ouch. Sorry to hear that :/

While technically true, that's disingenuous. You paid no additional marginal cost. The incentive structures matter.

I agree incentive structure matters, and it's why I consider the OHIP model superior: "I need care and it's already paid for, so I get it", vs the US model "I pay more upfront to do the triage nurse's job myself so I can then pay again if I do decide to see the doctor after all and geez I hope I can afford the bill when it comes"

GP is not the one being disingenuous.

Who do you think is being disingenuous?

Interestingly, in the UK they had a large "this is not an emergency" campaign trying to make people to choose GPs over emergency services.

And provide us with a dedicated phone number staffed by people trained to identify whether it is, in fact, an emergency, who will tell you to call an ambulance if necessary.

Taking a kid with fever to the ER is about as basic as you get.

Doesn't the US have out-of-hours pharmacies, or out of hours doctors, or urgent but not emergency treatment centres?

Not really. There are non-ER/non-hospital urgent-care centers, but they usually keep to roughly normal business hours. For after-hours care, the ER at a hospital is often your only option.

Depends on where you are. Some places have 24-hour Urgent Care centers that can handle the basic stuff that doesn't need a real ER.

But many places don't have any kind of Urgent Care centers, much less one that is open 24 hours a day.

Yes, that's why I said "usually" and "often".

For those from tri-state area: folks, PM Pediatrics is a blessing. They're open till midnight, waiting times are reasonable and they are billed as PCP by the insurance.

Yep. Usually the rule of thumb is:

* Potentially life-threatening emergency: ER

* Something like a broken bone or fever that needs to be fixed asap, but not life-threatening: Urgent Care

* Everything else that can wait a bit: regular doctor appt

Yes, kind of. They can handle a few things (ear aches, something that requires anti biotics, basic pain relief) with a nurse practitioner.

Not really. I live in Queens, NYC and there's no 24 hour urgent cares I'm aware of within a 30 minute drive.

An emergency room is a fairly regular visit if you are a parent. I have three young kids and all of them have been to emergency at least a few times — you'll call the government hotline, they'll tell you how urgent it sounds, then you go

They don't want anyone to risk staying home with their child if there's a chance that they are in danger

This is in Australia and there is no cost for this

I'd be careful you're talking about the same thing as a US ER because there are two other places you can take your kids in an "emergency" in the US that are not called ER: you can go to the kid's pediatrician who will have emergency appointments during roughly the same hours stored are open (e.g. Saturday and Sunday); and there are Urgent Care centers that are usually open late into the evening 7 days or possibly 7*24h. Urgent Care have basic X-ray and will stitch up pretty bad gashes. I have two kids and we've only been to the ER one time when my son was in anaphylaxis. Broken arms, facial lacerations, were handled at Urgent Care.

I've been to the ER half a dozen times with my son (reactive airway issues every time he gets a cold). It's totally something we could manage at home, but it took forever to convince our GP to prescribe the necessary meds (she was more comfortable with us going to the ER, despite the cost (both financially and the added stress of packing up a 1 year old to go to the ER)).

Can confirm in Australia "emergency" does mean the department with the giant red emergency sign at your local hospital.

We have late-night general practitioner services here (at least in the city), which I have used for less-urgent stuff.

In Australia, you can also call a home visiting doctor outside business hours & on weekends, they'll come to your house in O(hours) and diagnose you for free. If you have some private health plans on top, they'll dispense basic meds like antibiotics on the spot as well. Far more convenient and likely cheaper to the taxpayer than waiting around ER for hours with a cranky baby with an ear infection.

I'd say that it applies even more to an emergency room.