Hospitals as we know them in the United States are struggling with financial viability as they are caught between the pinchers of providing healthcare gratis to ER walk-ins and the die-off of private, healthcare insurance.
At this time, hospitals are not allowed to refuse medical care to a patient who enters their Emergency Room. Think about it, a patient might be so ill that they are unable to communicate their insurance coverage. The hospital treats them anyway and then attempts to recover their costs.
The other jaw of the vise is that Obamacare vaporized healthcare-as-we-knew which stratified risk and allowed insurance companies to deny coverage based on preexisting conditions it but said it would all be OK because the law passed by Congress and signed by Obama had mandates that penalized every American who did not have Obamacare compliant coverage.
The public was enraged when they saw what "their fair share" of Obamacare was and Congress repealed the mandates but left the parts about not stratifying risks and preexisting conditions in place.
So we now have a system where a very large portion of the population is either not covered at all or is covered by Medicaid which does not pay enough to cover the economic cost of coverage.
Furthermore, we have a system where a person can roll-the-dice and not pay into the system while young and healthy but can apply for coverage while in the ambulance on the way to treatment** and thus qualify for Lexus-level coverage.
The hospital systems, a very important part of the ecosystem that provides healthcare to nearly every American, are reeling.
Delivery of healthcare through the Emergency Room setting is astronomically expensive compared to other healthcare venues.
One attempted solution
Sparrow Hospital is the dominant hospital system in Lansing, Michigan. Their main campus is located on the eastside of downtown and is within easy walking distance of the homeless center, bars, weed shops and sex-workers.
|Homeless camp in Lansing, Michigan 3700 feet walking distance from Sparrow Hospital Emergency Room|
On cold nights the hallways are clogged with homeless people* sleeping on gurneys having been admitted by reciting a litany of symptoms they know will get them admitted for the night. The fact that the labs will be swamped and many diagnostic tests will not be run in a timely fashion (they are being TREATED, don't you know) does not bother them but can be problematic for patients who really are suffering chest-pains.
On nights when "the checks" hit the bank accounts, there are waves of calls from the residential neighborhoods where recipients of those funds decide that riding an ambulance over to Stober's bar beats the hell out of walking or waiting for the bus.
Sparrow Hospital's solution was to open an Emergency Room in Okemos eight miles from the main campus. The new Emergency Room is far away from titty-bars and other attractions and it will remain that way because it is close to a school complex. It is also not supported by much of a facility which necessitates boxing-up and shipping out serious issues to the main campus.
All of the professional medical people were flabbergasted by the decision. From their viewpoint, it was rock-solid-stupid.
But from the standpoint of it being an intermediate step toward closing down the Emergency Room at the main campus it makes all of the sense in the world. It is a filter and a triage center. It also happens to be located in Lansing's most affluent suburb and presumably the population with the highest percentage of private healthcare insurance.
The business model would be to only allow patients with a referral from an approved, medical professional to be admitted to the main campus.
*You can usually tell by the condition of their socks. Dirty socks/feet = Homeless.
** Kubota was recently a passenger in a vehicle that was involved in a traffic mishap where the vehicle he was riding in was totaled. The cop who responded looked at the driver and KNEW he was not insured. The cop said "I am going to investigate the accident scene before I take your information, so while I am over there looking at that tree...call your insurance carrier and bring your account up-to-date."
The driver did and the insurance company did, indeed, verify that the driver was paid-in-full and the driver had coverage when the cop tapped the query into his computer.
Had Kubota been injured in the accident (he wasn't), his medical bills would have been covered by the car insurance carrier.