At every one I have been to (not a lot I admit, maybe 4 in my life), I had to both provide insurance card AND pay my copay before a doctor would see me. Without payment, they send you to go to the ER.
Your point is orthogonal to the point of the article.
If we don't see them in the ER, it makes sense that they're staying home on purpose, or not handling symptoms until it's too late (?).
The amount of non-emergencies the ER department sees is astounding.
What's wild is that we structure payment and regulatory models where a walk in at the ER costs more than a walk in at the urgent care located literally next door. Gotta self assess how serious the situation is if you don't wanna contribute to the high risk revenue pool.
Kaiser heavily pushes their nurse hotline to help minimize costs. I can hardly fathom going to either the Kaiser emergency or injury departments[1] without calling the nurse hotline. The nurse, in consultation with a staff physician in the call center, does an assessment, tells you what to do next, if anything, and schedules any appointments--phone physician, in-person primary physician, or calls ahead to the emergency or injury clinic to minimize wait times.
Our current healthcare system is so fractured that most people have no idea how to go about seeking healthcare in the most convenient and smoothest way possible. Smaller regional hospitals and even some regional systems don't have the scale to do what Kaiser does, at least not nearly as efficiently as Kaiser. High costs are baked into the system.
[1] Injury department is for broken bones, cuts, etc that happen during the day. At the SF Geary medical center they're conveniently located across the hall from the imaging department.
I was accustomed to urgent care without a phone call. I tried to apply that experience to Kaiser. I found a Kaiser facility, via their web site, that claimed to offer urgent care during certain hours. I even double checked the definition of "urgent care" on wikipedia. I arrived at listed opening hour. The security guard I found there didn't know anything about it, except that no one else would show up for another hour. Then I wandered around trying to figure out where "urgent care" was, but there was some confusion about it. Eventually, I got to a desk somewhere. I was told to call for an appointment, which I did from there. All in all I spent three or four hours waiting and shuffling around between different desks. It was a very frustrating experience.
Eventually, I found out that everything in Kaiser starts with a phone call. But I don't think I was ever told that. What you're supposed to do, as far as I can tell now, is just call the number on your card any time you want to do anything.
The hospital is liable for the costs in the ER, so fuck no are they going to tell you go home and get some rest if they can charge you $2000 to do that after taking your insurance.
Update: whoever downvoted this, I challenge you to state why.
Kept avoiding ER, I felt bad wasting time. Plus money.
Finally went in and they ran an extra test and found the issue. Probably had seen 30 doctors during all of this.
Some of the doctors were amazed I hadn’t dropped dead yet.
> One study collected data from nine hospitals across the country, focusing on a crucial procedure used to reopen a blocked cardiac artery after a heart attack. The hospitals performed 38% fewer of those procedures in March, compared with previous months.
> At Harborview Medical Center in Seattle, Dr. Malveeka Sharma has tracked a 60% decline in stroke admissions in the first half of April compared with the previous year
> MUSC, a major stroke center, averaged 550 calls per month over the past four months about possible stroke patients from the 45 to 50 emergency rooms that refer patients. But it has seen just 100 in the first half of April, said Alex Spiotta, director of neurovascular surgery.
This is not just happening at ERs, this is happening at the places ERs will refer you to, usually after checking whether you do in fact need immediate care.
I had to visit the ER recently. I did not want to go but my doctor insisted. A family member who is also a doctor also insisted I go.
The ER was eerily empty. The ER doctor saw me immediately. There were only a couple of other patients that I could see. This contrasts to prior experiences in the ER where there is a long wait as I get triaged, with lots of people waiting to be seen.
Fortunately my situation was nothing serious. When I returned home and told my relative, he said his hospital's emergency department was also very light. In his opinion, there were a lot of people going to the ER who didn't need to go in the first place.
Edit: I am referring to non-trauma related admissions to the ER. E.g. I have a headache and I am going to the ER to be seen now.