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American Crisis: The Emergency Room - Updated 1/16/01

© Adelle Vancil Tilton

Part Two: The Role of HMO's in the ER crisis

One of the problems with the insurance coverage crisis that is facing patients today is the advent of managed health care. There are horror stories galore regarding the treatment of patients in hospital emergency rooms by various managed care organizations and HMO's. Concerns over financial savings have often overcome the concern for patient care according to many experts in the field.

When these organizations deny essential services due to the recommendations of non-medical personnel who have never seen the patient, they endanger the lives of patients and force physicians to deny care to those truly in need because HMO's or insurance companies are denying or delaying treatment. This in turn causes huge backlogs of patients, often sitting for hours in the emergency room waiting for the approval of their insurance company before they are seen, and when denied, their care is being withheld. These delays, compounded nationwide, appear to be creating many of the situations which increase costs and possibly cause the crisis to deepen.

HMO's also place caps on payments for various services therefore forcing physicians and hospitals to choose between providing the appropriate care for their patients and losing money or denying that treatment and still losing money. This has forced many hospitals and physicians to reconsider whether it is worth it to continue serving the public. When the costs get to the point that they are prohibitive, services are reduced, staffs are cut, and overcrowding increases. These combinations simply expand the problem and it becomes a vicious cycle that can eventually lead to a suspension of services.

Obviously, something needs to be done to address this problem. HMO's and insurance companies deserve to exist and make a profit for their stockholders. No reasonable person would think otherwise. On the other hand, patients need appropriate care, not controlled by financial decisions and physicians and hospitals need to be able to provide that care as they feel is appropriate for their patients. What is the best way to solve this problem? That is the subject of continuing discussion within the healthcare industry. Whatever the outcome of these discussions, one thing is certain. This problem must be addressed. It will not go away. Without some workable solution, we will continue to lose emergency services and the physicians who provide them, and the impact of doing nothing will be catastrophic for the nation.

The American Hospital Association came out with a news release today, January 16, 2001, pertaining to the problem of emergency room services. It is presented to illustrate the current nature of this problem.

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