Paying for hospital emergency care under a single-payer system

Duckett, Stephen; Jackson, Terri

doi:10.1067/mem.2001.111576

Cited by 12 publications

(9 citation statements)

References 20 publications

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“…There are two major philosophical approachesone based on throughput measurement, either per capita or adjusted for casemix, and the other based on the concept of role delineation -emergency response, institution role and availability, with only small adjustments for volume. 30 The difficulty with fee for service in EM is that it is possible to generate any number of EM visits to increase revenue. It also does not encourage patients to seek alternative services or other providers to take responsibility.…”

Section: Funding Modelsmentioning

confidence: 99%

International emergency medicine: Past and future

Cameron

2014

Emerg Medicine Australasia

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Much has been written about the development of emergency medicine (EM) and its impact on the medical system as a whole. It is still described as 'new' and very much seen as a specialty that is evolving, rather than a static domain of knowledge and skills with rigid boundaries. In reality, the fundamentals of emergency treatment in mitigating the effects of acute illness and injury go back to ancient times.1 This is evidenced by descriptions of the urgent management of acute pain with analgesics, splinting of injured limbs, and more sophisticated procedures, such as the removal of kidney stones and craniotomies. The treatments at that time were limited, but the application of these skills brought relief to many people (and a little pain). The practitioners were generalists and did not limit themselves to emergency treatment alone.Over the past half-century, there has been an acceleration of development in emergency medical treatments and a massive explosion in emergency medical system enhancement. This has resulted in a unique body of knowledge and skills, with the evolution of a new medical specialty specific to the delivery of emergency medical care. It is worth reflecting on the drivers for EM specialisation, where the specialty has come from, and what we can expect as the complexity of medical care increases with technological innovation and social changes associated with increasing connectivity.

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Section: Funding Modelsmentioning

confidence: 99%

International emergency medicine: Past and future

Cameron

2014

Emerg Medicine Australasia

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“…The cost infrastructure of EDs contains a fixed and variable component. The fixed component represents the standby capability while the variable component is directly related to patient throughput and complexity 60. On the other hand, private hospitals are mostly funded by patient payments.…”

Section: A Conceptual Framework For Triagementioning

confidence: 99%

Republished paper: Emergency department triage revisited

FitzGerald

Jelinek

Scott

et al. 2010

Postgraduate Medical Journal

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Triage is a process that is critical to the effective management of modern emergency departments. Triage systems aim, not only to ensure clinical justice for the patient, but also to provide an effective tool for departmental organisation, monitoring and evaluation. Over the last 20 years, triage systems have been standardised in a number of countries and efforts made to ensure consistency of application. However, the ongoing crowding of emergency departments resulting from access block and increased demand has led to calls for a review of systems of triage. In addition, international variance in triage systems limits the capacity for benchmarking. The aim of this paper is to provide a critical review of the literature pertaining to emergency department triage in order to inform the direction for future research. While education, guidelines and algorithms have been shown to reduce triage variation, there remains significant inconsistency in triage assessment arising from the diversity of factors determining the urgency of any individual patient. It is timely to accept this diversity, what is agreed, and what may be agreeable. It is time to develop and test an International Triage Scale (ITS) which is supported by an international collaborative approach towards a triage research agenda. This agenda would seek to further develop application and moderating tools and to utilise the scales for international benchmarking and research programmes.

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“…Although, as the study authors note, general practitioners working in EDs in the United Kingdom have been shown to be more cost-efficient than junior medical staff in the same environment, the actual cost of emergency medicine is dominated by infrastructure and staff expenses 24 hours per day. 6 EDs have a high average cost per patient and a low marginal (incremental) cost for additional low-acuity presentations, especially compared with off-site after-hours clinics, where expenses are dominated by medical labour, and the average and marginal costs are much A EDIT ORIAL S closer together. Even if patients were 100% interchangeable, a new after-hours service would likely represent an increase in total cost to the community, because it would not reduce the need for the "public good" of a 24-hour service available at the hospital.…”

Section: Drew B Richardsonmentioning

confidence: 99%

Primary care services and emergency medicine

Richardson

2010

Medical Journal of Australia

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Paying for hospital emergency care under a single-payer system

Cited by 12 publications

References 20 publications

International emergency medicine: Past and future

International emergency medicine: Past and future

Republished paper: Emergency department triage revisited

Primary care services and emergency medicine

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