The Hospital Emergency Department as a Social Welfare Institution☆,☆☆
Section snippets
INTRODUCTION
The hospital emergency department holds a special position in American society. Easily accessible and always open, the ED is one of the few institutions available to help all persons, all the time, without reservation. Such a guarantee of assistance is so important that it has been enshrined in a federal law requiring EDs to evaluate everyone seeking care.1 Yet, despite the immense social power inherent in such an arrangement, most physicians and civic leaders see the ED as a purely medical
EMERGENCY DEPARTMENTS IN AN ERA OF REFORM
EDs are busier than ever, with ED visits in the United States rising to more than 90 million per year.2 Canada’s single-payer system has not curbed ED visits, which increased 6% per capita in that country between 1985 and 1990.3 Managed care did not reduce ED visits among New York City Medicaid beneficiaries,4 nor did improved primary care access eliminate preferential ED use among disadvantaged children.5 Although Medicaid beneficiaries and the uninsured are already overrepresented in the ED,6
THE HEALTH AND WELFARE OF THE DISADVANTAGED
The ED may remain the only site “where the most disenfranchised can be reached,”10 but most EDs, like other parts of the health care system, have not assumed responsibility for the “social care” of the disadvantaged. Some community clinics had previously used Medicaid reimbursement to finance social and health service coordination for the poor,11, 12 but competition for managed care contracts will likely force many clinics to scale back such assistance.13 Some health maintenance organizations
THE SOCIAL ROLE OF THE EMERGENCY DEPARTMENT
What can the ED do for the social care of the disadvantaged? Perhaps one answer lies in a comprehensive system for social screening, evaluation, and service coordination, a system designed to work in conjunction with emergency medical care. The ED could establish a “social triage” center of sorts, to which ED patients identified with pressing social needs could be referred for screening evaluation and service coordination, using preexisting community resources. The social triage center would be
SOCIAL CARE AS A PUBLIC SERVICE AND PROFESSIONAL RESPONSIBILITY
Some have suggested that intensive social intervention in the ED can decrease hospital utilization rates,39, 40, 41 but evidence of cost savings is far from definitive. Although social programs such as nutritional assistance and Head Start have shown tangible benefits,11 the impact of comprehensive social screening, referral, and service coordination in a broad community population remains unproved. Research is currently under way to evaluate the economic effect of an ED-based program for
References (45)
- et al.
Project ASSERT: An ED-based intervention to increase access to primary care, preventative services, and the substance abuse treatment system
Ann Emerg Med
(1997) - Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 (PL 99-272, 42 USC, 1395dd,...
- et al.
National Hospital Ambulatory Medical Care Survey: 1996 emergency department summary
Health Information Division, Policy, Planning and Information Branch, Health and Welfare, Ottawa, Canada, 1992; cited in Weil T: Clinton’s health reform and emergency department volumes: a return visit [editorial]
Ann Emerg Med
(1993)- et al.
Evaluation of Medicaid managed care: Satisfaction, access, and use
JAMA
(1996) - et al.
Access to care for poor children: Separate and unequal?
JAMA
(1992) Emergency Departments: Unevenly Affected by Growth and Change in Patient Use
Current Population Survey
(March 1997)- et al.
Ambulatory visits to hospital emergency departments: Patterns and reasons for use
JAMA
(1996) - The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 ; analysis prepared by the American Public...
A public health approach to emergency medicine: Preparing for the twenty-first century
Acad Emerg Med
Welfare and the well-being of children
An evaluation of the impact of maternity care coordination on Medicaid birth outcomes in North Carolina
Am J Public Health
Paying the price: Medical care, minorities, and the newly competitive health care system
Milbank Q
Eye on America
Legislation extends SHMOs through ‘97
Modern Healthcare
Socioeconomic status, John Henryism, and hypertension in blacks and whites
Am J Epidemiol
The weathering hypothesis and the health of African-American women and infants
Racial and socioeconomic disparities in childhood mortality in Boston
N Engl J Med
Poverty and childhood chronic illness
Arch Pediatr Adolesc Med
Does increased access to primary care reduce hospital admissions?
N Engl J Med
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2022, Journal of PediatricsEducational Intervention in the Emergency Department to Address Disparities in Stroke Knowledge
2022, Journal of Stroke and Cerebrovascular DiseasesBetween Emergency Department Visits: The Role of Harm Reduction Programs in Mitigating the Harms Associated With Injection Drug Use
2021, Annals of Emergency Medicine
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Address for reprints: JamesA Gordon, MD, MPA,Department of EmergencyMedicine, University of MichiganHealth System, 6312 Medical Science Building I, 1150 West Medical Center Drive, Ann Arbor, MI 48109-0604;313-647-4844, fax 313-647-3301;E-mail [email protected].
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