โ Scribed by Thomas P Weil
No coin nor oath required. For personal study only.
INTROBUCTION President Clinton's proposed health reform plan 1 would provide universal access for emergency department benefits with hospital costs to be constrained by managed care plans and global budgetary targets. Conventional wisdom 2-4 suggests that ED volumes should decrease as the 35 million uninsured Americans become eligible for unlimited coverage for visits to primary care physicians' offices. Some recently acquired Canadian data 5 suggest that if Clinton's current health reform proposal is enacted, the nation's EDs might be faced with more volume and less reimbursement per unit of service.
The average cost per discharge (in 1990) in a Canadian hospital was 41.7% less than among acute care facilities in the United States. North of the border they are able to manage with only 3.3 full-time equivalent employees per occupied bed, whereas American hospitals use 5.5 full-time employees per occupied bed. Adjusted for differences in our respective average lengths of hospital stay, acute care facilities in the United States require 12.7% more full-time employees, and yet each year we deliver 21.1% less emergency and outpatient visits per capita. 5
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