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LA Health Access Crisis: The Emergency Medical System Example

LA Health Access Crisis: The Emergency Medical System Example. Steven M. Asch MD MPH VA, UCLA, RAND. Testimony Before the Assembly Select Committee on the Los Angeles County Health Care Crisis February 25, 2005. Unique Features of the EMS. Safety net for all – regardless of insurance

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LA Health Access Crisis: The Emergency Medical System Example

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  1. LA Health Access Crisis: The Emergency Medical System Example Steven M. Asch MD MPH VA, UCLA, RAND Testimony Before the Assembly Select Committee on the Los Angeles County Health Care Crisis February 25, 2005

  2. Unique Features of the EMS • Safety net for all – regardless of insurance • Only part of health care system with mandated access • “Canary in a coal mine”

  3. Access Balances Supply and Demand

  4. EMS Supply Decreasing • Number of ED’s declining • ED Beds per capita declining • Hospital chains divesting • National problem, worse in LA

  5. Why is Supply Decreasing? • Uncompensated care • Decreasing public insurance reimbursement • Seismic retrofitting costs • Rising technology and drug costs • Nursing shortage • ED on-call physician specialist shortage

  6. Demand Outstrips Supply • Overcrowding • Ambulance diversions • Long waiting times • Not confined to poor areas

  7. Why is Demand Increasing? • More uninsured • More underinsured • Sicker ED patients • National problem, worse in LA

  8. Potential Solutions • Direct subsidies through taxes • Increasing ED patient enrollment in public insurance programs • Case management • Shifting care to lower intensity settings • Public private partnerships – information exchanges • Regional planning

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