the Natural Condition

Health Affairs released a report yesterday (March 10th) that outlined trends in American Emergency Department wait-times between 1997 and 2004. They considered three overlapping cases: all patients (18 and older), patients with ‘emergent’ conditions as indicated by triage staff (should be seen within 15 minutes), and patients with an eventual diagnosis of acute myocardial infarction — heart attack. On the whole, the median wait time to see an ED physician increased 36%. While wait times for ‘all patients’ and ‘emergent patients’ increased by about 40% per year (22 to 30 minutes, and 10 to 14 minutes, respectively), the change in the ‘AMI patient’ wait time dwarfed them both:

During the 7 years examined, the median wait time for patients eventually diagnosed with AMI increased by 150%, from 12 minutes in 1997 to 20 minutes in 2004. That is truly shocking news. Cardiogenic-shocking news, to be precise (pardon the pun).

In the decade from 1994 to 2004, total ED visits increased by about 18% (from 93 million to 110 million, annually). Emergency Department closures — as many as 12% during the decade — compounded the boom in visits. “Other likely contributors include inpatient bed shortages leading to bottlenecks in the ED; increasing uninsurance; population aging; shortages of staffing, space, and interpreters; and difficulties assuring non-ED follow-up care.” The sum of which totaled to a crucial deferral of care in the neediest patients. The authors of the paper raise the important point that staggering wait times, or even the misgiving of staggering wait times, will cause many prospective patients to avoid the ED altogether.¹

Wide-angle reports like this one demonstrate that all the ingenious, expensive, life-saving interventions are worthless if we do not first step back and survey the simple obstructions to keeping people healthy. We might do well to count something on this scale more often.

Reference:
(1) Waits To See An Emergency Department Physician: U.S. Trends And Predictors, 1997–2004. Health Affairs. 2008. [full text - restricted access] The full article contains many more interesting statistics about wait-time changes in sub-populations (race, gender, region, etc.).

Health Affairs, a journal dedicated to health policy, published an article today that reports on the forecast for healthcare spending in the US. In 2007, America spent about 16% of its Gross Domestic Product on healthcare. By 2017, that number is expected to rise to about 20% of GDP (a total of about $4.3 trillion). A 4% increase may not seem like much, but it represents a proportional growth that outpaces the adjusted growth for the 2017 GDP. By my calculations, the dollar amount of a 4% increase in healthcare-spending-as-proportion-of-GDP would cost more than current budgets for the Department of Defense, Homeland Security, Education, and Energy, combined.¹ The following chart shows the forecast for this increase:

^{Image courtesy of Health Affairs.}

This growth is equivalent to about a 6.7% increase in Read the rest of this entry »