Tuesday, July 18, 2006

News Release: It's not the uninsured and the undocumented crowding our ERs

Surprise, surprise! What we thought we knew about ER overuse is not correct, according to a newly released study by the Center for Studying Health System Change:

Hospital Emergency Department Use Varies Greatly Across the United States

Contrary to Conventional Wisdom, Communities with More Uninsured, Hispanic or Immigrant Residents Generally Have Lower Levels of Emergency Department Use

Press Release
July 18, 2006

FURTHER INFORMATION, CONTACT: Alwyn Cassil (202) 264-3484 or acassil@hschange.org

WASHINGTON, DC—Contrary to popular belief, communities with high levels of uninsured, Hispanic or immigrant residents generally have much lower rates of per person hospital emergency department (ED) use than other communities, according to a study by the Center for Studying Health System Change (HSC) published today as a Web Exclusive in the journal Health Affairs....

...Despite common perceptions that high rates of uninsured and immigrant residents contribute to higher ED use, communities with the highest levels of ED use generally did not have the highest numbers of uninsured, low-income, racial/ethnic minorities or immigrant residents....

...while a rapid influx of immigrants may contribute to ED crowding in some individual hospitals—particularly along the U.S.-Mexico border—immigration is not a major contributing factor to ED crowding nationally, even in many communities that have a large population of Hispanic immigrants.

"Hispanic immigrants—a high proportion of whom are uninsured—are not heavy users of EDs compared to other individuals, including whites with private insurance," Cunningham said. "And their numbers are still too small in the vast majority of communities nationwide to have a major impact on the health care system in those communities."

For example, noncitizens in 2003 on average had about 17 fewer ED visits per 100 people than citizens, while uninsured people had 16 fewer visits on average than Medicaid patients, about 20 fewer visits than Medicare beneficiaries and roughly the same rates as privately insured people....

Read the full news release at the web site linked above.

I always suspected it wasn't as simple as everyone made it seem to be. Things generally are more complex than they appear to be on the surface; a good reminder about knee-jerk reactions to perceived problems, probably.



Thursday, July 13, 2006

Change of Shift is up at Emergiblog

The hardest-working nurse of the blogosphere has started a blog carnival starring nurses: "a nursing homage, if you will, to the great tradition of Grand Rounds. An amazing array of wonderful stories from nurses, patients and doctors are here for your perusal this week."

Check it out at Emerigiblog!


Thursday, July 06, 2006

Definitions vs. Understanding

The major problem with designing a label for a category of human being is the subsequent feeling that the ability to label a concept means we understand the concept. The other major problem is that labeling people by categories implies both inclusion and exclusion and thus limits (by the very act of labeling) recognition of complexity. Labels simplify, and in doing so, eliminate complexity and cause us to concentrate on similarity rather than difference.

If you are a health professional, look around you today when you get to work. Think of the professionals around you as a group, and you will notice that you are surrounded by a group of human beings that, for the most part, are above average in intellectual capacity and performance. They are, for the most part, college graduates with a certain kind of intelligence that includes the ability to absorb and retain large amounts of knowledge about the human body and psyche. You are recognizing something about a self-selected group of people and we are going to label these individuals "mildly to moderately gifted".

Which is true. As a group and as individuals, that label defines something about the intelligence and ability of that cohort.

But the truth of the label doesn't cause us to understand that cohort, either as a group (an entity) or as individuals within the group. We know next to nothing about individual abilities within the group. We can't account for one person's ability to play the violin and another's ability to finish advanced Sudoku puzzles faster than anyone else; nor for this surgeon's specific ability to understand spatial relationships and that therapist's specific ability to understand body language. We can only say that within the range of "mild to moderate giftedness" there are individual strengths and weaknesses.

Further, if you look closely at that group we have now labeled, you will see many more differences. We won't all look alike, for one thing. We are different ages, races, sexes, and body shapes. We come from different ethnic and religious backgrounds. We have different sexual orientations. We are single and married, parents or non-parents, children of living parents or orphans. We like different books, we attend different churches, and we speak different first languages. We are as diverse as we are similar.

This concept doesn't seem difficult to understand, because we are living inside that group. We know it, we experience it daily, and we have self-reference. We understand that a label of "giftedness" implies only one thing, really, about the group we exist within.

Yet this seems a difficult concept to get across when discussing the label "mental retardation". We look around a selected group of people with functioning at the level that would allow us (using our professionals guidelines) to label them as "mild to moderately mentally retarded" and inevitably we focus on similarity.

But in reality, the individuals in THAT group are no more alike than the individuals in OUR group. That is misunderstanding.

That is the danger of labels.

If you want to begin to understand the individuality of each human with whom you have contact, begin to look around at the groups you find yourself in. Practice focusing on similarity and then difference. This is the first step to recognizing within yourself how the labels you put on people limit understanding of them as human individuals.