When ‘l’hôpital’ is the wrong destination
Those seeking medical treatment when abroad all too often head to the nearest emergency room (ER), believing it to be the best place to receive appropriate and timely treatment. Philip Brun explains why an ER is often not the best place to be, however, and looks at the role insurers can play in preventing ER overuse
First published in the 2012 ITIJ Cost Containment Review
Those seeking medical treatment when abroad all too often head to the nearest emergency room (ER), believing it to be the best place to receive appropriate and timely treatment. Philip Brun explains why an ER is often not the best place to be, however, and looks at the role insurers can play in preventing ER overuse
It’s the first night of a family’s long-planned vacation to Disney World in Orlando, Florida, when their five-year-old daughter Antoine comes down with serious flu-like symptoms: coughing, dizziness, difficulty swallowing, cold sweats, and high fever. Sophisticated Parisians though they might be, they have no idea how to navigate America’s complicated healthcare system. So they gather their family, hail a taxi outside the hotel, and instruct the driver “L’hôpital, s’il vous plaît!” Despite every good intention, they may have just made entirely the wrong call.
Navigating the US healthcare system
The US healthcare system is the world’s largest, most costly and complex, and international visitors face special challenges navigating its waters if they need care while travelling. For example, there are more than 600,000 doctors, 60,000 pharmacies and 6,000 hospitals across the US. With so many options in the country’s healthcare delivery system, where should a family take a sick child first? What might be Antoine’s most appropriate point of entry into our complex healthcare system?
Many people in the US and abroad mistakenly believe that a large number of common medical conditions are best treated in an ER. In fact, estimates from the US Centers for Disease Control and Prevention illustrate that almost one-third (32 per cent) of the 124 million annual American ER visits are considered non-urgent or semi-urgent. From blisters to minor burns; sprains, strains, and fractures; to flu symptoms and finger wounds; patients have a habit of flooding US emergency rooms with non-urgent illnesses and injuries that could just as effectively be treated at other medical facilities, such as an urgent care centre, a physician’s office, or a retail clinic.
patients have a habit of flooding US emergency rooms with non-urgent illnesses and injuries
The emergency room, however, must remain just that – a special place for the treatment of life-threatening or very serious conditions that require immediate medical attention, such as possible heart attacks and strokes, uncontrollable bleeding, unconsciousness, or other major traumas. This does not mean that illness or injury should be ignored. Urgent care centres, in particular, can treat many serious health conditions that consumers might commonly rush to the ER to treat – such as stomach viruses and flu symptoms, sprains, strains, fractures, and cuts. There are over 8,700 urgent care centres in the US: most accept major health insurance, do not require an appointment, and are considerably less expensive than an emergency room. In a case like Antoine’s, patients will be in and out much more quickly than the hours typically spent in a hospital emergency room.
Another appropriate option for visiting non-US residents who need healthcare services might be a retail health clinic – also commonly known as a convenient care clinic – a care facility traditionally located in a shopping mall, pharmacy, or other retail setting. The clinics are staffed by nurse practitioners and physician assistants and offer services for minor, non-urgent health conditions (including minor infections, skin conditions, minor cuts, and earaches). Consider the case of a business executive who takes an overnight flight Sunday evening and feels the onset of terrible, flu-like symptoms just prior to his/her important Monday morning meeting. Rather than languishing in the ER for hours, the executive could visit a non-acute care centre for treatment that could be as simple as a much-needed vitamin booster shot.
These alternatives are not only more appropriate for the treatment of certain medical conditions, but far less expensive than a trip to the emergency room. UnitedHealthcare data shows that the average total cost of a visit to the ER in 2010 was approximately $1,300, while the average total cost of a visit to an urgent care facility, physician’s office, and convenience care clinic was $175, $105, and $73, respectively. Increased awareness about the appropriate use of ER services also translates into savings for the entire US healthcare system. A study published in the September 2010 issue of Health Affairs estimated that redirecting non-emergencies to alternative care centres could lead to annual cost savings of up to $4.4 billion in national US healthcare spending.
Beyond the prohibitive costs of unnecessary visits to the emergency room, it is equally important to consider the benefit of avoiding prolonged, stressful waiting times. According to the American College of Emergency Physicians, US ER room patients spent an average of four hours and five minutes in the ER, a figure that has only increased in recent years. Meanwhile, 80 per cent of all urgent care visits in the US are finished in 60 minutes or less, according to the Urgent Care Association of America. And, really, who wants to spend four hours on a Friday night during a holiday or business trip being shuffled between victims of violent crime or traffic accidents knowing you’ve been delegated to the bottom of a waiting list?
Arming visitors with knowledge
If we know the answers to why we need to change visitor behavior concerning ER overuse (namely, the savings in time and money), the question for insurers is: how to raise awareness among visiting non-US residents about the costs and delays of relying on the ER for medical care? How can we communicate this clearly and effectively to policyholders and help holidaymakers, business people, and students make the right choice rather than rushing without a second thought straight to the emergency room?
Insurance companies can offer pre-travel education about appropriate emergency room use with simple explanations about the US healthcare landscape, policies, and procedures on their websites or in printed collateral materials such as travel policy brochures. Once travellers are abroad, the companies can offer emergency room education through multilingual call centres dedicated to international traveller queries and readily accessible mobile apps and online directories that can direct insurance holders to non-urgent care alternatives. The secret to success, in this regard, is to provide travellers with information that is portable and easily accessible. It is unlikely that someone is going to pack a lengthy policy brochure along with their business suits; however, providing a wallet-sized card or membership card with the essential information will enable a just-in-time referral resource. The same is true of websites and mobile apps. The trick is to enable the insured to access them easily when needed, rather than expect people to bookmark or download them prior to travel.
Insurance companies can offer pre-travel education about appropriate emergency room use
Once accessed, these advances in technology and telemedicine help make it easier and faster for visitors to find the right care wherever they might be. In addition to 24/7 telephone assistance, Antoine’s family also could benefit from online provider directories that enable members to locate the most convenient appropriate provider. Some insurers are testing free mobile apps that can be downloaded to mobile devices to help users locate nearby physicians, urgent care centres, and hospitals (e.g., ‘this retail health clinic is just three minutes from your hotel and has an average wait time of 12 minutes’.). Telemedicine and mobile healthcare applications can be especially invaluable when people are visiting rural and remote locations in the US. Several US insurers are now providing these direct to nurses and physician communication channels that offer diagnostic capabilities and coordination of care services via the phone or web.
International insurers looking for a US partner that can help alleviate the high costs and inconvenience of relying on emergency rooms should seek one that offers both web and mobile tools to help members find convenient care centres as well as one that provides live telephonic assistance to help customers. Knowing the treatment options available and understanding what distinguishes a true medical emergency can help keep travellers out of US emergency rooms, and keep vacation and business travel plans on track. It’s a win-win situation that helps patients, insurers, and the US healthcare system overall. The savings – in terms of time, cost, and hassle – just might have everyone saying, “Merci!”