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The ethics of access: Comparing 2 federal health care reform efforts
Date:2/20/2013

of individuals in urgent or emergent situations, and did not address how to make all people in the U.S. healthier, say the authors. They cite the need for a balanced health care system that focuses on both illness and wellness, and allows patients and providers the chance to work together to prevent illness and save money.

Co-author and U-M emergency medicine physician Kori Sauser, M.D., notes that while the ACA comes closer to changing that perspective, it does not go far enough.

"As the provisions of the ACA kick in, millions more people will have access to primary care providers and preventive services like vaccinations and routine screenings for high blood pressure and cancer," says Sauser, who is also a RWJF Clinical Scholar. "Even so, demonstration projects haven't convinced us that patients will choose primary care offices over the emergency department for their acute care. A major missing piece in the ACA is in failing to determine how to connect emergency care with primary care resources in ways that meet patients' needs."

EMTALA, which requires hospitals and providers to evaluate, stabilize and provide basic lifesaving treatment to any patient who comes to an emergency department or is in active labor, was passed during President Ronald Reagan's administration. It does not allow a patient's ability to pay to be considered during emergency care.

Its ethical core, to ensure access to care in medical emergencies, includes an acknowledgement of "community responsibility" and "historic standards" in health care.

But in the years since, it has led patients who do not have insurance or the ability to pay for care out of their pocket to rely on emergency rooms for care. That in turn has burdened hospitals and led to spending that doesn't take advantage of potentially cost-saving primary and preventive care.

The authors note that ACA does not expressly lay out the way to integrate the emergency and primary c
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Contact: Kara Gavin
kegavin@umich.edu
734-764-2220
University of Michigan Health System
Source:Eurekalert

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