Quality of care issues
1. What are the causes of crowded emergency rooms?
Overcrowded emergency rooms have long waiting
times, routine diversions of ambulance drivers and are not available
to all patients who need them.[1]
More than 65 emergency rooms have closed in California during the
last decade.[2]
There are multiple reasons for these problems. A national study finds
that uninsured visits to emergency departments increased by about
10 percent despite a smaller percent change in the number of uninsured.[3]
During the same period, visits to physician offices by uninsured persons
declined by 37 percent. Higher caseloads and lower reimbursements
from public and private payers compelled many medical practices to
limit care provided to uninsured patients.[4]
The study also finds that even though uninsured
visits did increase, they did not account for most of the increase
in emergency room use. Instead, those insured by private plans and
by Medicare together accounted for about two-thirds of the overall
increase in emergency room visits. The number of privately insured
people alone accounted for more than half of the increase in usage
during this same period.[5]
One complaint compelling the insured to seek emergency room treatment
is the frustration many of the insured have with the
current outpatient system. Unable to get in to see their primary
care doctor in a timely manner, people with insurance go to the emergency
room and are diagnosed, tested and treated in one visit.[6]
In contrast, SB 840 provides comprehensive health
care for every resident and a system that eliminates or diminishes
most of the above problems. When everyone has health coverage and
can choose his or her primary care doctor, long waits and overcrowded
emergency rooms will no longer be the norm.
2. How does SB 840 improve care quality?
Studies show Americans get only 54 percent of
the medical treatments they need, even if they have good insurance
and go to a good doctor and an accredited medical center.[7]
The National Academies’ Institute of Medicine finds that Americans
are experiencing an epidemic of sub-standard care that they term a
"quality chasm”—a wide gulf between the care needed and the care
actually delivered to patients.[8]
SB 840 creates a publicly financed health care
system that provides comprehensive health coverage based on one standard
of care for all residents. At minimum, the new system provides methods
to improve care quality that include primary and preventative care,
evidence-based standards of care to help doctors make accurate decisions,
mandatory reporting of errors, teams that evaluate the effectiveness
and safety of new technology, and funding for development of electronic
medical records and compatible computer systems.
3. Can individuals choose their own doctor?
SB 840 provides that every resident can choose
his or her own primary doctor and dentist. Women also can choose their
obstetrician-gynecologist as well as a primary care doctor. Restrictions
by HMOs and insurance companies on who can provide health care to
patients are eliminated. SB 840 allows residents to choose a fee-for-service
doctor or a doctor employed by a health care system like Kaiser. Primary
care providers and emergency doctors will make referrals to specialists.
However, a patient also can see a specialist without a referral, but
in this case, they will have to pay out of pocket.
4. Would SB 840 stifle innovation?
SB 840 would stimulate innovation. Lack of money
and markets stifles innovation.
The market for health care innovations would
expand because 36 million Californians would have access to quality
health coverage and would get medical care as needed. The expansion
of the new health care system would create the demand for more goods
and services that would result in more state revenue, some of which
could be invested in well-funded budgets for research and development.
SB 840’s Partnerships for Health provides health
care grants for communities to develop innovative programs.
SB 840 provides for a statewide database of
information about what is needed to provide care quality. This information
could be a source of new ideas.
5. How does SB 840 decrease medical errors?
Errors would decrease as the new system implements
human and computerized error-check systems on a statewide basis. Such
systems are now used successfully in the Veterans' health system,
Kaiser, and in other countries that have universal health care systems.
Also, errors due to understaffing, the lack of readily accessible
medical information, poorly coordinated medical services, and inadequately
coordinated care would decrease.
6. Does SB 840 address the nursing shortage?
The
nursing shortage cannot be solved overnight. Lack of funds for training
nurses is a major part of the problem. SB 840 provides for a publicly
financed health care system that can set priorities, which can include
investing in nursing education. As
overall functioning of the new health care system improves, working
conditions and factors contributing to the shortage of nurses can
be removed.
