Emergency Medical Services for Children (1993) / Chapter Skim
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9 IMPROVING EMERGENCY MEDICAL SERVICES FOR CHILDREN: LOOKING TO THE FUTURE
9 IMPROVING EMERGENCY MEDICAL SERVICES FOR CHILDREN: LOOKING TO THE FUTURE
Pages 321-335
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From page 321... ...
have not been addressed. A systematic assessment of benefits and costs of EMS-C is needed, :but serious conceptual arid practical questions remain unanswered.
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From page 322... ...
Assessments of preventable deaths are often used to evaluate the effectiveness of trauma centers (as remarked in Chapter 7J. Other, indirect measures include less delay in reaching definitive care and reductions in suboptimal care, from which inferences are made about long-run benefits to health and wellbeing.
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From page 323... ...
Benefits of injury prevention programs have been documented as well. For example, through an energetic and effective nationwide injury prevention effort, Sweden reduced the rate of fatal injuries in 1- to 4-year-olds from 55 per 100,000 population (in 1957-59)
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From page 324... ...
For example, reimbursements based on diagnosis-related groups tend to underestimate the level of care required for victims of major trauma; the numbers of uninsured patients are not decreasing and may indeed be increasing; and trauma center costs cannot be covered, with cross-subsidies less available and~infusions of state funds less likely. Reimbursements for primary care are also problematic, and to the extent that they are very low in the Medicaid program, they are a disincentive for office-based physicians to accept Medicaid patients and an incentive for such patients to continue to rely on hospital emergency departments (EDs)
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From page 325... ...
Although EMS-C concerns are not likely to determine the answers to these questions, EMS-C will certainly be affected in important ways by the decisions that are made. Health care reform promises to have the most far-reaching effects, but increasing pressures on hospital EDs are a more immediate concern.
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From page 326... ...
Furthermore, virtually every part of the health care sector has experienced increases in expenditures both the private and public sectors, both feefor-service and prepaid capitated systems, and both inpatient and outpatient care. Increases in employers' group health insurance premiums have been very steep in recent years, although the upsurge may have been dampened by other changes in the health insurance picture; these include more utilization management, more health maintenance organizations (HMOs)
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From page 327... ...
EMS and EMS-C systems around the country must, therefore, consider these points. The number of health care reform proposals circulating in Washington by year-end 1992 was large and growing (AMA, 1991; Blendon et al., 1992)
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From page 328... ...
Answering these questions will have immense ramifications for EMS and EMS-C. This committee takes the position that those responsible for the future of EMS and EMS-C must become knowledgeable in the technical aspects of health care reform proposals.3 The proposed national advisory council (and state councils in those states where significant reform changes are under way)
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From page 329... ...
Emergency Care Personnel Emergency care providers themselves are among the scarce resources in EMS. The loss of volunteer emergency medical technicians (EMTs)
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From page 330... ...
Fifth, COBRA and OBRA can complicate efforts to make appropriate referrals to primary care providers, if ED obligations to patients without a need for emergency care are not clear. The demands created by these requirements along with the financial burden of inadequately reimbursed care are leading some hospitals to limit us snare one emergency services they provide.
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From page 331... ...
(Conversely, however, providing alternative, accessible primary care services can change ED use tPaneth et al., 19791.) Many factors can make primary care services difficult to get, particularly for working-poor and low-income families who may lack health insurance altogether.
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From page 332... ...
Factors such as lengthy and detailed application forms, documentation requirements to verify information supplied, literacy and language difficulties, as well as the complexity of the Medicaid program itself (with multiple eligibility categories and income scales) , lack of automation of the eligibility determination process, lack of outreach to provide assistance to potentially eligible individuals, and inadequate staffing in the Medicaid offices have been found to hinder Medicaid enrollment in the District of Columbia (GAO, 1992~.
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From page 333... ...
and services are reimbursed by third parties at levels sufficient to cover the ED's costs, having the capacity to deliver primary care services may make it easier or more affordable for hospitals to acquire and maintain high-technology equipment and to have adequate numbers of specialists on the staff to cover true emergencies around the clock. Most agree, of course, that this is an expensive way to provide primary care.
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From page 334... ...
. Necessary steps include the following: making insurance compulsory if universal access is a goal; ending medical underwriting and continued segmentation of the risk pool if the private insurance market is to be a responsible part of the financing of health care; developing clearer and more realistic estimates of expenditures and genuine options for financing and for cost containment; enhancing efforts in quality assurance and improvement and practice guidelines; and attending
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From page 335... ...
One addresses the complexities of employment-based health insurance, with particular emphasis on financing and cost-containment options (IOM, 1993c)
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