There in an article in today’s Press Register touting the opening of several “Urgent Care” centers in the Mobile area. The writer presented this as a huge plus for the healthcare consumers as they could have their “deep cuts” or “sinus infections” cared for in a more timely fashion than in the traditional emergency room. Aside from the more mundane concerns of whether we need a center for this type of suturing (realistically you can do this in between patients in an efficient emergency department as you wait for MVAs to roll in) or sinus infections (think antibiotic resistance), the real issue is one of efficient and effective care delivery. These “centers” are part of the problem. The New England Journal of Medicine has had a series of “Perspectives” about the health-care system in this country. Last week, the essayist compared our countires experience with that of others. As we are all now familiar, we spend twice as much per capita and have much poorer outcomes than all other industrialized countries. In this weeks NEJM, Victor Fuchs points out three “inconvenient truths” about health-care. The first is that the annual growth will lead to healthcare consuming 30% of the GDP within 30 years, an unsustainable expenditure of public dollars for what is mostly (in the case of the American health-care system) a private good. The reason for this growth (Truth 2) is increased access to technology and healthcare infrastructure regardless of incremental cost/benefit to the individual patient or society. Truth 3 is that sick people tend to be poor and well people have to pay for sick people. To quote Dr Fuchs “No country achieves universal coverage without subsidization and compulsion, but U.S. politicians tie themselves and the health care system in knots by proposing reforms designed to conceal these realities. Politically, the most appealing plans are those that mislead people into thinking that someone else is paying for their insurance. Currently more than half of insured Americans obtain their coverage through employment, and workers have been led to believe that their employer bears most of the cost of their care — a belief that labor-market experts have concluded is invalid. When a firm pays $3,000 to $7,000 per worker per year for health care, it can get that money in only three ways: reducing potential wage increases, increasing prices for what the firm sells (which means lower real wages for workers everywhere), or lowering profits.”

The illustration at the top of this post identifies 15  necessary interventions to get control of our health care costs. Many of them involve reinvigorating the primary care infrastructure in this country. None of them identify “increased urgent care access” as the answer. Even though our newspaper doesn’t get it, I hope that the policymakers do.

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