I am delighted to see the original blog post acknowledging the huge, albeit quiet, contribution urgent care centers make to the delivery of health care in the U.S.

Lou Ellen Horwitz
Executive Director
Urgent Care Association of America

The point is that the Commonwealth metric consisted of asking regular primary care practices whether they provided after hours care. When they said they didn’t, Commonwealth concluded that the US health care system is inferior.

Accuracy would dictate that Commonwealth researchers recognize that in the US system primary care practices don’t offer after hours care because there are practices that specialize in it. This may be a more efficient way of organizing a health system than the European model due to the efficiency advantages of specialization.

The number of urgent care practices is rather more than the “handful” you referred to. The Urgent Care Association of America says that in 2008 there were 8,000 urgent care centers in the US. There were about 4,600 emergency rooms.

Rather than consider whether the 8,000 urgent care practices provide adequate after hours care, Commonwealth appeared to assume that because primary care practices don’t keep late hours, people in the US have no access to health care outside the emergency room.

The comments about ER costs and the choices of the poor are not germane in this context. Commonwealth was surveying primary care practices, not ERs. Primary care practices are for routine care that people routinely expect to pay for.

Ability to pay is also not at issue here. Cmmonwealth was looking at population medical care, not specifically medical care for the poor. In the US, 80+ percent of people have some sort of third party payment health insurance. A significant fraction of the remainder is eligible for Medicaid, which people can enroll in after they need health care.

The comment that urgent care centers are not as well equipped as an ER is also not applicable as the Commonwealth study was limited to primary care practices which may not be as well equipped as an urgent care center.

Finally, it is not clear that your statements about ER payment policies is correct. Hospitals are becoming much more sophisticated about collecting from ER patients whether or not they plead poverty when they arrive.

Another hospital trend is a determination to collect of cash payments if you want treatment at the ER and your condition isn’t serious. The ER staff will do free triage. If your condition isn’t serious, an increasing number of hospitals will then demand cash to continue. People who demand free care may be offered a regular appointment at the hospital’s federally qualified clinic.

I’m sure a hospital emergency room would be more expensive, but hey aren’t running an emergency room. They have very a limited scope and don’t have equipment or resources of a hospital emergency room. They are more like a free standing clinic that’s open all night.

This clinic is sliding scale, too, but the docs are experienced, board certified.

When my mother was dying, our doc gave us her home phone # and told us to call any time.

Health care needs some tinkering, but it doesn’t need a massive federal government train wreck disguised as “reform”.