Friday, August 24, 2012

NEJM: "The Waits That Matter"

A sad story in the NEJM, "The Waits That Matter".

Crowded EDs are only one part of the problem. Inefficient hospital operations are another. Death, disease, and injury occur around the clock, but many hospitals still operate the majority of their services only 5 days a week. A growing number of specialists are either refusing to take after-hours call or demanding payments for doing so. After-hours and weekend gaps in coverage have real consequences; mortality rates associated with acute myocardial infarction and other time-critical conditions are significantly higher on weekends than on weekdays.

The waits that matter are those for emergency treatment such as defibrillation for out-of-hospital cardiac arrest, surgical management of traumatic injuries, initiation of antibiotic treatment for meningitis and other deadly infections, and percutaneous coronary intervention for acute myocardial infarction with ST-segment elevation. The passage of the Affordable Care Act may actually make stories like my mother's more common, as 32 million more Americans seek access to an emergency care system that is already overwhelmed.
Adding a medicine tag to the blog as this will become a bigger issue in thinking about macroeconomics.

As much as I enjoyed the compounding pharmacists giving it to K-V Pharma, can anyone argue that retail pharmacists are not a total joke? If you go to the doctor and he prescribes antibiotics, why can't the doctor just sell them to you? Why do you have to go to a Walgreens so that a guy who makes $80k can take three hours to put them in a bottle? Can you imagine any other industry getting away with that inefficiency?

More broadly: be positive on anything that makes our broken health care system function a tiny bit better. Minute clinics, for example. 

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