New York Ambulance. Ambulance in Russia and the USA: who is ahead of the rest

In America, no one wants to end up in the emergency room. Photo: depositphotos.com

Recently, my son Oscar and I played Russian roulette with American medicine. Translated into Russian, this means that we visited the emergency department of the hospital ( emergency room).

I have repeatedly heard stories of Russian-speaking immigrants who preferred to endure pain, turn to third-party specialists, or cope on their own, rather than end up in the emergency room and then receive a horrific bill. However, we had no choice, since the child was injured.

What happened?We were getting ready for a walk, Oscar dropped a ceramic plate on his foot, the nail on his big toe turned blue and I, not having a built-in X-ray, decided to go to the doctor. Moreover, Oscar whined pitifully and, when I touched my finger, burst into tears.

First, we called the pediatricians' association where all our routine visits take place. Since it was already 5 pm, the administrator said that they could no longer accept us in this department and, moreover, they did not have x-rays. And she offered to make an appointment for an x-ray early in the morning in their other department. Or go to the emergency department of the nearest children's hospital - Joe DiMaggio. Over the phone, the girl assured us that our insurance would most likely be accepted and we would not pay anything.Phew, well, at least that made me happy.

My husband arrived and we went to the children's hospital.When we arrived, we had to fill out several documents, after which we were invited to the reception department to wait.

This is what the emergency room at a children's hospital looks like. Photo: from the author’s personal archive

The reception area was quiet, calm and very bright. The chambers were separated by thin multi-colored curtains. Stationary system air conditioning, as usual, helped us cool down and then freeze. By the way, yes, take jackets to the hospital and all government institutions. It's somehow especially cold there.

Staff were scurrying back and forth in the hall, but we didn’t see a single patient.

A nurse met us and, having clarified the nature of our problem, offered to wait a little in the room behind the curtain. A little bit resulted in forty minutes, during which Oscar, who had already returned to normal, walked around the entire department 4 times and checked the serviceability of all devices.

One of the hospital's treatment rooms. Photo: from the author’s personal archive

The doctor, as usual with a retinue of assistants, appeared for a few minutes and, without even touching a finger, asked to wait for the x-ray. I don’t know why they couldn’t immediately send me for an x-ray. Apparently these are the rules. Sometimes in America they are illogical.

We waited another hour for the X-ray, during which Oscar re-examined the department and it finally became clear to us that we had come in vain. After all, he didn’t complain about his finger at all.

My husband and the child went for an x-ray. I managed to do the procedure only the second time and it took about fifteen minutes. Oscar did not want to put on a protective vest and give his finger to the investigation. The whole squad came running to the boy’s screams.

After the x-ray, the child calmed down, and we waited another twenty minutes to hear from the doctor who appeared for a moment that there were no fractures or cracks in the finger, and if the nail swelled, we would need to appear tomorrow and pierce it.

It took a long time for Oscar to get an x-ray. Photo: from the author’s personal archive

We were given a reminder at home about such problems and what to do in their case. They didn’t offer us an X-ray, but here it is a rare event. Everything must be asked for, because it is not provided for in the protocol.

After 2.5 hours, we, tired but happy that there were no serious injuries, went out onto the rain-smelling street and drove home, fearfully awaiting the bill, the amount of which is a secret until the moment we receive it.

Newspaper The Washington Post published research on medical bills per visit in a 2013 article emergency room and found that the average bill is equal to a month's rent (about $1,300), which is really a lot even for a wealthy American. Moreover, the same disease can cost from 4 dollars to 20 thousand. I'm serious. How can you not worry?

Luckily, the insurance company covered every last cent. I was never lucky enough to find out the total amount, because the bill went directly to the insurance company.

Life in New York: American Medicine. Ambulance October 3rd, 2010

Why did I decide to translate this rather long article?
It gives a good insight into American EMS and portrays the realities of Brooklyn very similarly

Thomas Hazaz wanted to go outside. Lying on a gurney, with sensors on his chest, he tried to persuade the emergency room doctors from the Maimonides Medical Center to let him go. In less than 24 hours he should be in tuxedo and accompany his youngest daughter in the marriage ceremony. Hazaz, 52, a bartender from Bay Ridge, kept saying that his elbow pain was just a result of excessive lifting. Doctors, however, suspected a heart attack.
"On a scale of 1-10, my pain is about 1," the patient stated, "I took painkillers. I know what's wrong with me. I've always diagnosed myself."
Then the nurse found a swollen vein and inserted a needle to draw blood.
"Ooh, that hurts." This time he did not rate the pain on a scale.
It was Tuesday evening, around 10 o'clock. Hazaz was delivered from the restaurant where he worked half an hour ago. Dr. Sal Suau, one of the forty doctors in the local emergency department, had some bad news:
"You'll have to stay here for a few more hours."
A few hours later, the bride's father heard the final verdict - the "pain in the elbow" turned out to be a heart attack. The staff prepared him for an angiogram to determine which artery was blocked.
“How are you feeling?” asked Dr. Hillary Cohen, who was informed not only of the patient's condition, but also of his daughter's wedding.
“I’m desperate,” said Hazaz, holding back tears, “I won’t be able to attend my daughter’s wedding. This happened at the wrong time.”

An event like this always comes at a bad time, but almost every American will be in an emergency room at least once in their lifetime. Some will have heartbreaking memories, others will remember the feeling of relief. Some will face ineffective treatment, others will receive high-quality professional help.
Maimonides, a hospital in Borough Park, Brooklyn, known for its success in treating heart disease and stroke, is the fifth busiest in the country.
In 2009 there were 109,000 sick here - up from 97,000 in 2008 and 81,000 in 2005. Hazaz was one of 294 sick this Tuesday, and one of 1,511 this entire summer week.

Mondays are the busiest days. "People put off urgent problems health until they get here," says Dr. Joshua Schiller, 42, who taught high school economics, worked as a carpenter and rode a motorcycle around America before going to medical school. "The challenge," he continues, "is to identify those who need immediate attention." help from chronically ill patients."

Of the 7,240 people who passed through the emergency room at Maimonides,
66% had government insurance (Medicaid for the poor and disabled, Medicare for the elderly),
18% - private;
16% - without insurance (like Mr. Hazaz).
Last year, $38 million was not paid for medical services, more than in the previous year - $31 million.

The area where Maimonides is located is immigrant, and the hospital has 46 interpreters for patients who speak 70 languages. Although the hospital is not a dedicated trauma hospital (where people are admitted with gunshot wounds or after accidents), most arrive in critical condition. But many come with chronic illnesses - diabetes, asthma or gastrointestinal problems; often because they don't have a primary care physician or don't want to wait to see one.

A week spent in the quiet of the Maimonides ambulance (87 beds on an area of ​​2000 sq.m., staff - 80 people) demonstrated the "glitz and poverty" of a dynamic and overloaded system and showed city life from an unusual perspective.

In five days, six people found out they had cancer, six women discovered they were pregnant, one child swallowed a coin, and a man broke a wooden ear stick... inside his ear. Eight people arrived with appendicitis, 14 with heart attacks and 18 with strokes. One died.

A mother encourages her teenage daughter in Chinese, a father calms his preschooler in Bengali, a Hasid in a long black robe talks to his father in Yiddish, an elderly woman switches back and forth between Russian and English.
“Controlled chaos,” Dr. Cohen calls the emergency room. But it is also a place of cooperation and compromise, hard work and tragedy, a place in which there is always a storm and where everything is driven by humor and endurance.

Dr Jonathan Rose looks very young
"What happened today?" he asks patient Joseph Batiato, 88 years old.
“I don’t know,” replies Mr. Batiato, who is in the acute care ward.
"Where are you?" the doctor asks an unexpected question.
"In Maimonides," the patient answers as if his life depended on it.
Batiato, a WWII veteran, has serious problems with the stomach, which explains food poisoning. Dr. Rose orders an endoscopy and blood tests.
Marion, Mr. Batiato's wife, looks at the doctor skeptically.
"You look like a child," she says.
“I’m already 35,” he replies, “I could be president. Do I look unpresidential?”
“No,” she says.
“Why, maybe because I’m not black?” Dr. Rose reacts, causing everyone to laugh.
Suddenly Mr. Batiato bursts into the conversation:
"What am I doing here?"
Dr. Rose replies, “I ask the same question every time I wake up.”

The hospital naturally has many elderly patients, who often arrive seriously ill, frightened and alone.
On Monday, Grigory Fridman, a senior nurse who grew up in Belarus, spent hours holding the hand of a 97-year-old patient who was in pain and near death, soothing him in Russian. A person who did not have family in the US was assigned a "do not resuscitate" and "do not transfer to" status. artificial respiration"To alleviate the condition, it was recommended to increase the dose of morphine, but Friedman, fearing that a high dose, lowering the patient's blood pressure, would kill him, introduced means to increase the fluid output. "The Angel of Death will take him, but not my actions," he says.
Two days later, Frances Wendroff, 95, who called an ambulance when she fell in her Coney Island apartment, calls for a nurse from her seat. Mary Rodriguez, 32, who has worked here for five years, pulls back the curtain, sits next to her and takes Frances' hand. The patient asks about her blood pressure, states that she is on Medicare, and then begins to talk about her poor vision. After listening, the nurse gently explains that she should approach other patients as well. “For me, being in hospital is heaven,” explains Frances. All my friends are dead, now my friends are audiobooks. I love listening to Danielle Steele. I like great love stories."

On Wednesday, around 3 o'clock in the afternoon, Dr. Schiller, lean, good-natured and bald, is almost finishing his shift. Or he thinks so (as a result he stays up to 5 hours). "Being here is like playing in a casino," he says, "you have no idea how much time has passed."

In the department "not urgent help"The doctor approaches the patients within 20 minutes. But then they can lie down for a long time while waiting for tests and repeated examinations - the average time spent in the emergency room is 3.72 hours.

The room is so packed that nurses, doctors and technical staff, making their way between the beds, perform the “you first”, “only after you” dance steps.
They like this busyness. They chose this field of medicine because of the adrenaline, diversity and camaraderie. But they also enjoy the silence. Although the word "calm" causes a stream of boos every time it is uttered. God forbid you say it and the red phone immediately rings (serious case) or three ambulances arrive.
"Emergency personnel are incredibly superstitious," says Ms. DeRienzo, "Some words you must not say, or you will be damned."
As in other hospitals, flocks of residents (trainee doctors working in the hospital) accompany doctors on their rounds. Here Doctor Sergei Motov, an immigrant from Latvia, is making his rounds.
“What happened?” he leans over the patient.
The resident explains that the woman was hit by a car five days ago while crossing the street. She was treated in a specialized hospital, after which she was sent home. But today she vomited twice. A CAT scan of the head and an X-ray of the chest and elbow were done.
“Why did she throw up?” Dr. Motov asks the resident in his “cat and mouse” style.
“Looks like a stomach,” the resident replies.
"Seriously?" mocks Motov. "She was hit by a car. Next time you tell me she has dengue fever or malaria."
A man with a sprained knee and a huge can of beer among his things. “You won’t drink here, will you?” asks Dr. Motov, picking up the can.
Next is a difficult case - a 20-year-old woman with a constant headache that causes her to tilt her head. Dr. Motov calls the stroke team and sends the patient for a CAT scan, but there is a queue before entering the room.
“I have an acute stomach, can I go first,” asks another doctor.
“I have a 20-year-old with a stroke,” Motov answers.
“Come in,” another doctor lets him in.

The night shift has its own rhythm - fewer chronic diseases, more alcoholics and psychiatric cases.

After 10 pm, an ambulance brings in a 54-year-old Chinese man in cardiac arrest following an asthma attack.
Nine staff surround him and Dr. Suau gives orders.
“There is no pulse,” the resident reports.
"Did you give him an epis (an injection of epinephrine, which makes the heart beat)?"
"Yes".
A paramedic performing CPR asks for backup.
Utrophine is administered.
Dr. Cohen listens with a stethoscope.
"How long has he been here?" she asks.
Six minutes. It seems like an eternity has passed.
"Guys, we have to accept the inevitable," Dr. Cohen says, giving up and looking at his watch. "10:44. Not good. So young."

The man's wife and two children are waiting nearby. Dr. Cohen delivers the terrible news through an interpreter. For the first time all week, the room is unusually quiet. And then a scream, uncontrollable and unforgettable...

And not far away, Hazaz, only two years younger than the Chinese, is sentenced to watch his daughter Danielle's wedding from his hospital bed. On next evening he smiles into the laptop as he watches his son lead his sister Danielle by the arm.
“Let’s greet the father of the bride,” the host calls.
After kissing her partner for the first time as a wife, Danielle leans towards the camera and blows a kiss to Hazaz.
"Hey, Dad," she says, in tears, "Look at my ring. I love you."
After this, Hazaz announces that it is now time to sleep.

Every time I am more and more surprised by the very well-thought-out medical care scheme in the United States from a business point of view, which, of course, was developed not to maintain the health of the nation, but to maximize the enrichment of those people who can lobby necessary law in Congress. But that is another topic.

I have already written about what “updated” is in general, now about the most terrible and dark side of medical care - this is ambulance or emergency care for patients.

It often happens that a person gets very seriously and suddenly ill, of course, he knows about emergency medical care, which is available 24 hours a day, he calls 911 or gets behind the wheel and rushes along the highway in the hope that his The kind uncle Aibolit will quickly cure you, but Aibolit is no longer the same and not at all kind. It seems to a person that the entire department of the hospital will now crowd around him, they will feel sorry for him, apply all the knowledge accumulated by mankind, and in 5 minutes he will go home healthy and happy. But American realities are a little different. Here, even in emergency care, you can wait an hour or more, see a doctor for exactly 1 minute, get a prescription from him for regular painkillers, and be healthy. No, the story doesn't end here. In a week, a person will receive a huge bill for saying hello to the doctor, and the bill can reach several tens of thousands of dollars. To prevent this from happening, you should know in advance what you might encounter in their hospitals.

The US medical care system includes 2 ways to help people as quickly as possible: Emergency Rooms and Urgent Care.

I will try to tell you what these dark horses are, what are their similarities and differences.

Emergency Room

Usually such help is available in every hospital or medical center. institution, open 24/7, 365 days a year, people come here without an appointment. It is to such departments that the police deliver all victims.

According to the Centers for Disease Control and Prevention (CDC), in 2012, Americans made 136.1 million calls to 3,900 emergency situations. medical centers nationwide, about 20 million of them were transported by ambulance. Considering that the country had a population of 313.9 million in 2012, approximately one in three of its citizens visited the emergency department.

When visiting such a department, the patient is assigned the degree of assistance he needs: from 1 to 5. The first degree is the most minor, for example, pain in the ear or head, the second level is for example, a wound requiring stitches, level 5 is already more serious problems such as a broken bone. There are also more high levels care for seriously ill patients who, for example, have rapid blood loss or cardiac arrest. According to statistics provided by the National Hospital Ambulatory Medical Care Survey, between 1/3 and ½ of all patients arriving in the emergency department are not in critical condition.

The main reason why there are so many non-critical visits from patients to this department is that the law provides for assistance to everyone, regardless of their ability to pay. Those. if you cannot pay for yourself (and this still needs to be proven), then come, they will serve you here for free. But if you have insurance, a job or another source of money, and you contacted this branch, then your accounts will be reimbursed in full.

Now comes the fun part - the cost of emergency room care.

The problem for the patient and the gain for the doctor is that in such departments there are no fixed rates, i.e. the patient cannot know in advance how much he will have to pay. The only thing the patient knows is how much his insurance company will pay for him. This is usually $150-250 per appointment. No insurance company offers a plan that fully covers the cost of emergency medical care (unless you specifically pay for insurance that covers this type of medical care). And this is not without reason.

The final bill from this caring emergency department depends on the severity level assigned to the patient, whether x-rays are necessary, laboratory tests, how much time the doctor spent caring for the patient (sometimes the cost of the doctor's time can reach up to $12,000 per hour), whether the patient was transported by ambulance help (this is an additional $400-1200) or it came with legs, also the price may depend on the state and on the clinic itself.

According to the Agency for Healthcare Research and Quality (AHRQ), average bill In 2009, emergency department charges were $1,318; in 2011, on average, patients with health insurance paid an additional $933.

Sometimes solvent patients without health insurance can receive a discount from the hospital: they will not include laboratory tests or x-rays in the cost of care, and may offer payment in installments. The generosity is incredible!

Costs for treating patients with the same symptoms can vary greatly. Based on a 2010 study of more than 4,000 emergency departments, a list of average prices for the most common diseases was compiled, and the list also included the minimum and maximum bills that patients received.

Those. A patient who comes to an emergency room plays Russian roulette: he never knows how much he will pay, for example, $15 or $17,797 for treatment of a headache. And often in such departments the patient does not even receive treatment (if the patient is not dying), but painkillers, sees the doctor for 5 minutes at best and receives a referral to the main doctor. I can say this based on reading more than 100 different doctor’s reports and patient reviews from forums.

One of the reasons why emergency medical care is so expensive is the law that obliges them to provide assistance to all patients, regardless of their ability to pay, and there are a lot of such patients, because all the poor people of the country come here for any, even non-urgent, complaint about health. And on average, emergency departments spend $18 million a year on such calls. Consequently, these $18 million then fall on the shoulders of those who can pay for themselves or those who have insurance. But after the new ObamaCare law, which requires every citizen to have health insurance, prices in such branches should decrease. But who would refuse a tasty morsel?

Emergency departments have also come up with another reason why their bills are so high: when they bill a patient, they are never sure that they will receive the full cost, so the bill is at their risk. The patient may be insolvent Insurance companies or government health care providers, Medicare and Medicaid, may set in advance the fixed prices it will pay for its “ward,” and the latter's rates are much lower than the rates charged by the departments to patients.

Despite such huge EDs (emergency medical care) bills, the government only provides $47.3 billion (about 2%) to cover the bills out of the $2.4 trillion spent annually on healthcare. low-income citizens in these branches.

So, what are Urgent Care Centers in the USA?

These are the same medical departments that provide emergency care to patients without an appointment within 20 minutes - 2 hours, often working around the clock and almost every day. Such centers are also almost always equipped with laboratory and x-ray equipment.

These units (always private) have been operating in many medical institutions for more than 30 years, now there are about 8,800 units throughout the country, each such unit serving an average of 342 patients per week. The average income of this part medical institutions totals $13 billion a year.

Urgent Care Centers differ from emergency departments only in that the former do not provide care to patients who are dying and in very critical condition. But at the same time, the difference in prices for the treatment of the same diseases with emergency departments is significant.

Approximate prices for emergency care centers for 2010

• Allergies: $97
• Acute bronchitis: $127
• Earache: $110
• Sore Throat: $94
• Red eyes: $102
• Sinusitis: $112
• Upper respiratory tract infection: $111
• Urinary Tract Infection: $110

The state does not pay the bills of insolvent citizens who seek help from the Urgent Care ambulance. Insurance companies also do not provide plans that fully cover emergency medical bills.

So, after all this information, we can draw one short conclusion. If you are not dying and are conscious, are solvent and know how to count your money, then you should seek help from the nearest Urgent Care center that accepts your insurance, and under no circumstances go to the Emergency Room if you are just having trouble. a bloody nose or a sprained leg. Even with a sprained arm, it is better to go to the emergency room, since the service there is just as fast as in emergency centers, but the bills are several times lower.

Every time I am more and more surprised by the very well-thought-out medical care scheme in the United States from a business point of view, which, of course, was developed not to maintain the health of the nation, but to maximize the enrichment of those people who can lobby for the necessary legislation in Congress. But that is another topic.

About the most terrible and dark side of medical care - this is ambulance or emergency care for patients.

It often happens that a person gets very seriously and suddenly ill, of course, he knows about emergency medical care, which is available 24 hours a day, he calls 911 or gets behind the wheel and rushes along the highway in the hope that his The kind uncle Aibolit will quickly cure you, but Aibolit is no longer the same and not at all kind. It seems to a person that the entire department of the hospital will now crowd around him, they will feel sorry for him, apply all the knowledge accumulated by mankind, and in 5 minutes he will go home healthy and happy. But American realities are a little different. Here, even in emergency care, you can wait an hour or more, see a doctor for exactly 1 minute, get a prescription from him for regular painkillers, and be healthy. No, the story doesn't end here. In a week, a person will receive a huge bill for saying hello to the doctor, and the bill can reach several tens of thousands of dollars. To prevent this from happening, you should know in advance what you might encounter in their hospitals.

The US medical care system includes 2 ways to help people as quickly as possible: emergency ( Emergency Rooms) and urgent ( Urgent Care) health care.

I will try to tell you what these dark horses are, what are their similarities and differences.

EMERGENCY ROOM

Usually such help is available in every hospital or medical center. institution, open 24/7, 365 days a year, people come here without an appointment. It is to such departments that the police deliver all victims.

As a rule, the medical team does not include a general practitioner and a paramedic. In the USA, a paramedic and a driver technician respond to a call. The tasks of the first include the practical provision of basic medical care, and the technician-driver is responsible for driving the carriage, loading and unloading the stretcher with the patient. It is curious that the salary of ambulance line crew employees, by American standards, is small - about 30-45 thousand dollars a year, which is three, or even four to five times lower than the income of doctors.

The organization of the work of the American ambulance is fundamentally different from the Russian service "03". If Russian doctors, who often respond to calls for any, often not the most urgent, issue, should, if possible, provide qualified medical care at home, then their American colleagues perform mainly transportation functions - to stabilize the patient’s condition and quickly take him to the nearest hospital.

According to the Centers for Disease Control and Prevention (CDC), in 2012, Americans made 136.1 million visits to 3,900 emergency medical centers across the country, about 20 million of which were transported by ambulance. Considering that the country had a population of 313.9 million in 2012, approximately one in three of its citizens visited the emergency department.

When visiting such a department, the patient is assigned the degree of assistance he needs: from 1 to 5. The first degree is the most minor, for example, pain in the ear or head, the second level is for example, a wound requiring stitches, level 5 is already more serious problems such as a broken bone. There are also higher levels of care for seriously ill patients who, for example, are experiencing rapid blood loss or cardiac arrest. According to statistics provided by the National Hospital Ambulatory Medical Care Survey, between 1/3 and ½ of all patients arriving in the emergency department are not in critical condition.

The main reason why there are so many non-critical visits from patients to this department is that the law provides for assistance to everyone, regardless of their ability to pay. Those. if you cannot pay for yourself (and this still needs to be proven), then come, they will serve you here for free. But if you have insurance, a job or another source of money, and you contacted this branch, then your accounts will be reimbursed in full.

Now comes the fun part - the cost of emergency room care.

The problem for the patient and the gain for the doctor is that in such departments there are no fixed rates, i.e. the patient cannot know in advance how much he will have to pay. The only thing the patient knows is how much his insurance company will pay for him. This is usually $150-250 per appointment. No insurance company offers a plan that fully covers the cost of emergency medical care (unless you specifically pay for insurance that covers this type of medical care). And this is not without reason.

The final bill from this caring emergency department depends on the severity level assigned to the patient, whether x-rays are necessary, laboratory tests, how much time the doctor spent caring for the patient (sometimes the cost of the doctor's time can reach up to $12,000 per hour), whether the patient was transported by ambulance help (this is an additional $400-1200) or it came with legs, also the price may depend on the state and on the clinic itself.

According to the Agency for Healthcare Research and Quality (AHRQ), the average emergency department bill in 2009 was $1,318; on average, patients with health insurance paid an additional $933 in 2011.

Sometimes solvent patients without health insurance can receive a discount from the hospital: they will not include laboratory tests or x-rays in the cost of care, and may offer payment in installments. The generosity is incredible!

Costs for treating patients with the same symptoms can vary greatly. Based on a 2010 study of more than 4,000 emergency departments, a list of average prices for the most common diseases was compiled, and the list also included the minimum and maximum bills that patients received.

Those. A patient who comes to an emergency room plays Russian roulette: he never knows how much he will pay, for example, $15 or $17,797 for treatment of a headache. And often in such departments the patient does not even receive treatment (if the patient is not dying), but painkillers, sees the doctor for 5 minutes at best and receives a referral to the main doctor. I can say this based on reading more than 100 different doctor’s reports and patient reviews from forums.

One of the reasons why emergency medical services are so expensive is the law that obliges them to provide assistance to all patients, regardless of their ability to pay, and there are a lot of such patients, because all the poor people of the country come here for any, even non-urgent, complaint about health. And on average, emergency departments spend $18 million a year on such calls. Consequently, these $18 million then fall on the shoulders of those who can pay for themselves or those who have insurance. But after the new ObamaCare law, which requires every citizen to have health insurance, prices in such offices should decrease. But who would refuse a tasty morsel?

Emergency departments have also come up with another reason why their bills are so high: when they bill a patient, they are never sure that they will receive the full cost, so the bill is at their risk. The patient may be insolvent, and insurance companies or Medicare and Medicaid may pre-set fixed rates that she will pay for her patient, and the latter's rates are much lower than the rates charged by departments to patients.

Despite such huge bills from EDs (emergency medical services), the government provides only $47.3 billion (about 2%) to cover the bills of low-income citizens in these departments of all $2.4 trillion that is spent annually on health care.

SO, WHAT ARE EMERGENCY CARE CENTERS IN THE USA (URGENT CARE CENTERS)

These are the same medical departments that provide emergency care to patients without an appointment within 20 minutes - 2 hours, often working around the clock and almost every day. Such centers are also almost always equipped with laboratory and x-ray equipment.

These units (always private) have been operating in many medical institutions for more than 30 years, now there are about 8,800 units throughout the country, each such unit serving an average of 342 patients per week. On average, the income of this part of medical institutions is $13 billion per year.

Urgent Care Centers differ from emergency departments only in that the former do not provide care to patients who are dying and in very critical condition. But at the same time, the difference in prices for the treatment of the same diseases with emergency departments is significant.

Approximate prices for ambulance centers:

Allergies: $97
Acute bronchitis: $127
Earache: $110
Sore Throat: $94
Red eyes: $102
Sinusitis: $112
Upper respiratory tract infection: $111
Urinary Tract Infection: $110

The state does not pay the bills of insolvent citizens who seek help from the Urgent Care ambulance. Insurance companies also do not provide plans that fully cover emergency medical bills.

So, after all this information, we can draw one short conclusion. If you are not dying and are conscious, are solvent and know how to count your money, then you should seek help from the nearest Urgent Care center that accepts your insurance, and under no circumstances go to the Emergency Room if you are just having trouble. a bloody nose or a sprained leg. Even with a sprained arm, it is better to go to the emergency room, since the service there is just as fast as in emergency centers, but the bills are several times lower.

The US healthcare system is by far one of the most expensive in the world. High prices for medical services artificially inflated by doctors and insurance companies. Ordinary citizens, fearing huge medical bills. services, buy insurance for themselves, doctors, knowing that people have insurance, set huge prices for their services, while insurance companies constantly increase rates, sometimes refuse to pay for some treatment or procedure, considering them unnecessary. As a result, healthy citizens with average or high income who pay insurance but don’t go to hospitals. At the same time, most medical plans have such a thing as Deductible - the amount that a person must first pay per year for all bills (bills are summed up) before the insurance company begins to pay its obligations. And it often turns out that the bills for medical service healthy person per year do not exceed this Deductible, therefore, the person pays in full all bills from hospitals and at the same time also insurance. For example, in the cheapest this moment According to plans, the size of Deductible is $4,500 - a fairly large amount that is difficult for a healthy person to reach.

Every trip to the doctor here turns into some kind of game of “who is smarter.” A living example. I recently visited a dentist who prescribed treatment for 3 teeth; taking into account insurance, I had to pay 140, 85 and 60 dollars for each tooth. What do most patients do? They blindly trust their doctor, come the next day, give money and treat their teeth. After I checked the prices for dental services on the insurance company’s website, I realized that I had to pay not the amount indicated by the doctor, but much less, 70, 85 and 35, respectively. I came to the doctor and said that I wanted to treat my teeth at different prices, he immediately agreed to my prices and treated my teeth, in the end, he still received his money from the insurance company. Here you need to, without hesitation, fight for every bill received from the hospital, because for most doctors, a patient is an ordinary bag of money.

One advantage worth noting American system healthcare means the technical equipment of hospitals: everything is at the highest level.

Health insurance has its pros and cons. On the one hand, it protects people from possible high bills for treatment, but on the other hand, if this type of insurance is completely removed, then prices in hospitals will immediately decrease to quite affordable.

In 2014, a sensational health care and patient protection reform in the United States called ObamaCare already came into force in the United States. According to this reform, all citizens and residents of the country must mandatory have health insurance. And here the first thing that comes to mind is: “Comrades Americans, where is your vaunted democracy, where is the freedom of choice?” What should those who do not want to have insurance, who consider themselves completely healthy, do? Nothing. You must either obey the law, or simply look for another country to live. After all, they live in their own “democratic” society, where everyone should help each other, but as always, this help should come only from more or less wealthy citizens who work and do at least something in their lives. The main thing is to convince society that its citizens should help each other. And, oddly enough, when we discussed this reform in college, and we discussed it quite often, in my two groups I was the only one who was against this innovation. Everyone else had one argument - we need to help each other.

So, what has changed in the US healthcare system after the introduction of ObamaCare reform.

The first thing that became very noticeable was, of course, the increase in fees for the insurance itself. For example, in 2013 I had a very good insurance plan from Kaiser Permanente (one of the best insurance companies) for which I paid $194 per month, now to get a similar plan from this company you need to pay $306 per month. Of course, most people for whom employer companies pay insurance did not even feel any changes with this reform. ObamaCare also took care of companies by forcing them to pay for their workers' insurance or face a fine.

With the introduction of ObamaCare, the government forced all insurance companies to provide 4 different medical plan(Bronze, Silver, Gold and Platinum plans) with different prices and coverages. At the same time, now the insurance company does not have the right to refuse insurance to anyone (this is certainly a plus), even if the person, for example, has AIDS or cancer. Before the introduction of this reform, insurance companies could refuse services to any person without explanation or charge him high monthly premiums, but now Monthly payment The cost of insurance is the same for everyone. Insurance companies, in order to “protect” themselves from the increased risk of paying for the treatment of their clients, raised fees for their services, which is why many healthy citizens were against this law, because did not want to take on insurance companies to pay for the increased risk. Now, in fact, a monopoly has been established on the market, which allows insurance companies to set the prices they want, and the state has provided them with a law that people will still buy their services from them. That's what good government, which does everything to provide its insurance companies with a constant income at the expense of the pockets of citizens with average and high incomes. Bravo!

At the same time, the state partially pays for health insurance for citizens whose income does not exceed four times the poverty threshold (in 2014, this amount is equal to $11,670 for a family of one person). In other words, this law applies to people whose annual income does not exceed the following values:

1 person in the family $46,680;
2 people in a family $62,040;
3 people in a family $78,120;
4 people in a family $95,400;
5 people in a family $110,280;
6 people in a family $126,360;
7 people in a family $142,440;
8 people in a family $158,520.

Under the ObamaCare reform, people whose income is within the above limits (familiesusa.org provides current income data) will pay from 2 to 9.5% of annual income for Silver Plan health insurance (here is described in more detail on how to calculate it) .

It is worth adding that there is another alternative program Medicaid is for people with incomes below 133% of the poverty threshold. Medicaid covers all medical services in full and is provided free of charge. Here is a table of the poverty threshold for families with different amounts Human:

1 person in the family $11,670;
2 people in a family $15,730;
3 people in a family $19,530;
4 people in a family $23,550;
5 people in a family $27,570;
6 people in a family $31,590;
7 people in a family $35,610;
8 people in a family $39,630.

If you take low-income family, then if previously the members of this family could not buy insurance for themselves, hoping that they would not get sick, now they are obliged to pay every month, even if not the full cost of insurance, but still they need to deduct some amount from their already low income. At least people before ObamaCare had a choice whether to buy insurance or not, but now they don't have that choice. For example, a family of 4 people has an income of 95,400 per year, it turns out that they need to pay 9.5% for insurance, which is $9,063 per year.

Those US citizens who do not have health insurance for more than 3 months a year will have to pay a fine at the end of the year, which will gradually increase until 2016:

2014: Minimum fine is $95 for each adult and $47.50 for each child, up to a maximum of $285 per family per year.
2015: Minimum fine is $325 for each adult and $162.50 for each child, up to a maximum of $975 per family per year.
2016: Minimum fine is $695 for each adult and $347.50 for each child, up to a maximum of $2,085 per family per year.

At the same time, I did not find information on the official websites about how these fines will be collected. There is only information that the tax service can demand a fine, but cannot force citizens to pay it, nor can it put them in prison or impose other penalties. The only thing the tax service can do is send another fine for failure to pay the first fine, etc. But I still wouldn’t avoid this fine, because who needs problems with the tax authorities?

You can’t be so smart and take out insurance only when you get sick, since you could apply for insurance only until May 2014 or from January 1, 2015 and for several months, and then again the opportunity to apply for insurance is closed.

In addition to the fact that ObamaCare protects patients and makes it possible for low-income citizens to receive medical care, the government also loudly says that this reform will create about 400 tons of new jobs, ensure an influx of new funds into the budget by establishing new taxes for wealthy citizens and pharmaceutical companies($409.2 billion). Overall, ObamaCare is a 10-year program that will cost the government approximately $940 billion.

ObamaCare, like many other state laws, benefits some, some do not feel any changes, and some suffer from this law. But it seems to me that ObamaCare primarily benefited the wallets of those who lobbied for this law in Parliament, and there is no doubt that these were the owners of insurance companies.