The Schumacher Group is out with a pretty interesting survey on emergency room issues, with implications for hospitals and payers in a couple of areas.  It says basically that:
— for most emergency rooms a lack of specialists both on call and for follow up care is a problem. This is leading to diversions to other ERs.  The  lack of interest from specialists in working on call in ERs is driven by fears of malpractice liability, and a lack of professional compensation for non-insured patients. Competition between hospitals for these specialists is also causing problems.
–significant amounts of non-emergent patients are showing up (nearly half of all patients in more than 50% of all EDs!)
–overcrowding is the single biggest problem in ERs

This survey essentially confirms that the ER has become the de facto primary care service for far too many people. Until we develop a universal insurance system with some kind of proper access to real primary care, we will continue to waste scarce resources.  Equally badly, those hospitals that can get away with it will close their ERs, making life all the more dangerous for all of us the next time we really need one. You don’t hear too much about this issue any more, which is a pity because it’s one of the few aspects of our health system where the mess we’re in can seriously affect even the wealthiest among us, and so there might be a willing coalition developed to fix it.