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Emergency Room Charges: A Tale of Two Systems

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Las Vegas, NVIn spite of proposed reforms—dubbed ObamaCare—to US health care, the fact remains that the US system continues to be firmly entrenched in a business model unlike countries such as Canada, which continues as a largely state-run system providing universal health care for the masses without the need for additional insurance. In Canada, at the end of the day, there is no bill for emergency room charges.

There is a growing debate over the way hospitals are run in the US, and how they manage their funding and revenue streams. At issue are charges for service, such as emergency room cost, that vary greatly depending upon who is footing the bill and the capacity to pay. Numerous advocates have highlighted costs and fees for service that are often thousands of dollars more at one facility, or for one patient, than they are for another.

There are allegations that hospitals in the US will take a loss for services on a patient without the ability to pay, only to inflate the cost of that service for a patient with greater means. It leads many better-heeled patients, who pay cash or handle everything through insurance, to dispute a medical bill.

In Canada, there are literally no emergency room fees to pay, beyond parking. Hospitals are managed at the provincial level (akin to a state level in the US), with funding coming from provincial and federal taxpayers. Health care has been a constitutional right for Canadians since the Pearson years in the 1960's, and beyond a handful of fees for service, no Canadian is ever faced with an emergency room bill or a massive invoice for surgery and an extended stay in hospital.

Hospitals in Canada are tightly regulated and required to operate with balanced budgets based on existing revenue. Any attempts at the kind of creative accounting allegedly undertaken by some US hospitals is met with swift reprisal that can ultimately affect funding.

In Canada, a hospital will not under-bill to an organization like Medicare or Medicaid, only to make up the difference with a more expansive er bill for a patient with insurance or a better financial footing.

In Canada, there are no inflated invoices that go out to insurance providers, with the full expectation that an insurance provider will whittle that invoice down to a more reasonable fee.

In Canada, there are no orders for tests, scans and other treatments that are not deemed medically necessary but allegedly ordered so the hospital can earn more from that patient. To wit, US patients with an inability or limited capacity to pay are thought to be treated with maximum efficiency and diligence to minimize the business loss to the hospital, whereas patients with adequate insurance are showered with more care than they need, allowing a hospital to increase emergency room fees, which constitutes hospital overcharging.

US patients with adequate insurance decry such practices, given their fear of higher premiums when thousands of dollars worth of er charges and other services were incurred.

Recently, a Canadian traveling in the US and experiencing a health scare on the road decided to take the time to be checked out in a new, state-of-the-art facility just off the Interstate. Following a battery of tests that proved nothing and an overnight stay in the hospital, the patient's out-of-country Canadian insurer was presented with a bill totaling about $15,000.

It is not known how much those services would be in Canada or if the US hospital inflated emergency room charges and initiated other services in order to derive as much benefit from the patient's insurance provider.

In a story published March 12 in the Las Vegas Review-Journal, a patient experiencing nausea was urged to have a CT scan of her abdomen. A US-based health care advocate noted that had the patient not possessed health insurance, "(the patient) never would have gotten that CT scan for suspected food poisoning," Dylan Roby, of the University of California, Los Angeles Center for Health Policy Research, said. "The doctor would have engaged in watchful waiting."

So long as the US health care industry is based on its current model, it is likely that emergency room charges will continue to be a subject of some dispute and debate.

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