ER

When you try to force-fit healthcare into the Standard American Business Model, you're probably going to get some pretty ugly results.

NYT:

In 1990, there were 2,446 hospitals with emergency departments in nonrural areas. That number dropped to 1,779 in 2009, even as the total number of emergency room visits nationwide increased by roughly 35 percent.

Emergency departments were most likely to have closed if they served large numbers of the poor, were at commercially operated hospitals, were in hospitals with skimpy profit margins or operated in highly competitive markets, the researchers found.

The number of ERs went down by 27% while the number of ER Visits went up 35%.  In any other business I can think of, that would indicate an impressive increase in Productivity.  But healthcare is not any other business; and Emergency Medicine is a perfect illustration of that fact.

The logic chain is fairly simple.  More patients going to fewer ERs means there are fewer caregivers per patient, which means less time can be allotted for each patient.  But treating Gun Shot Wounds and Blunt Force Trauma and Ischemic Attacks won't take any less time just because your business plan requires a greater throughput of patients.  Even with the amazing tools available to help staffers do things better, medicine is always more art than science.  It's about people; not gadgets.  The proper care of people requires time.  Take away their time, and people die.  Simple.