Re: After-Hours Doctor Calls Save Holland Money

On Jul 17, 8:38 am, Jim Higgins <gordian...@xxxxxxxxxxx> wrote:
After-Hours Doctor Calls Save Holland Moneyhttp://www.npr.org/templates/story/story.php?storyId=92606938

Morning Edition, July 17, 2008 · In the United States, the growing
number of uninsured Americans means more people do not have a family
doctor or primary care provider. When they suffer a worrisome accident
or problem, they may end up in the nearest hospital emergency room.

In fact, costs to hospital ERs have been growing over the past decade
and ERs nationwide have had to close their doors or limit their hours as
a result of out of control, burdensome costs.

Estimates vary but health officials suggest that as many as half of all
hospital ER visits are non-urgent, meaning those patients could be
treated effectively in a doctor's office or health clinic. But often,
people don't have that choice. They don't have a doctor, and there is no
health clinic nearby.

In the Netherlands, all citizens have access to 24/7 primary healthcare.
The system is organized much like a health maintenance organization, so
patients are required to get approval from their primary care provider
before they can see a specialist or go to the hospital.

The Group Nieuw-West (New West), a clinic in a low income neighborhood
in Amsterdam, is a good example of this 24/7 availability. It opens at 6
p.m., when most doctors' offices close for the day, and provides care
throughout the night until doctors offices open the next morning.

On a recent evening at 6 p.m., things at the clinic were already
beginning to bustle. A couple of doctors were gulping down dinner, a
paramedic checked his medical bag for supplies, and Lita Van den Burg
was beginning to field phone calls. Van den Burg is a physician's
assistant trained to figure out when patients can stay home and when
they need to come in to the clinic. She offers a variety of advice, such
as ointments for rashes, what to expect with an ankle strain or whether
a fever is serious or not.

Sometimes she'll tell patients to come into the clinic. On this night,
patients were treated by Dr. Nora Bartelsman, a family practitioner on
duty about three times a month. "Who do I see?" Bartelsman says, "I see
children with fevers, back aches, skin rashes, infected eyes, bladder
infections, anything. With the more serious situations, we'll visit
patients in their homes."

Just as Bartelsman is describing the process of house calls, the clinic
gets a call from the son of an elderly, bedridden man who can't come in
to the clinic. Bartelsman's colleague, Dr. Pascale Paques heads out the
door with her partner, paramedic Gerard Kuil. "The son can't judge the
situation," Paques tells us. "So we just have to go and have a look at
what's going on."

They drive around in what looks like a half ambulance, half taxi. It's
an Audi A4 painted bright yellow and blue, with a siren stashed inside
that can be put on top of the car. They have some medical gear but not a
lot. En route to the elderly man's home, a call about another patient
comes in and Kuil writes down the address. Soon they arrive at their
first stop.

Ushered in, Paques and Kuil head up a steep narrow staircase in a
typically small Dutch home. At the top of the stairs, they find two tiny
bedrooms with twin beds. A frail man lies in a sort of fetal position in
one of the rooms. The son stands a few feet away, wringing his hands. He
explains to the doctor that his father is 91 years old and unusually
listless. He won't get out of bed, not even to help his elderly wife,
whom he usually cares for.

As Paques begins the exam, she feels the man's forehead and his swollen
legs, takes his blood pressure and gently taps on his abdomen. Although
the man's calves and face are severely swollen, Paques decides this is
not heart failure and gives him an injection to relieve the fluid build
up. Then she hands the son a prescription for more diuretics, telling
him to check in with the doctors in the morning.

The second patient lives with his wife in an assisted living facility.
It's bright and clean, particularly compared with the first house. This
patient is also elderly, but he's up and about. The man describes
abdominal pain that has now subsided. Paques decides to do an exam
anyway, and gives him a clean bill of health. Meanwhile, a third call
has come in, and Paques and Kuil head to the home of a terminally ill
man with prostate cancer who's vomiting and can't seem to stop. The
vomiting is a symptom of chemotherapy. Paques gives the patient's a
prescription for anti-nausea medication. There's not much more she can do..

Back at the New West Clinic, Paques enters her notes about each
patient's treatment into their electronic medical records. Just like
their family physicians, she has access to all the information about
these three patients and can pass along what happened this evening. It's
a seamless communication system.

Paques is about to settle in and maybe even have some dinner when she
gets a call about another patient. An elderly diabetic woman is
disoriented and dizzy. The patient's son is on the phone, and Paques
knows this could be a serious situation. She nearly runs to the car, and
arrives at the home within 10 minutes. The patient's son, Rudolph
Heemeijer, is amazed at how quickly she got there "I was still hanging
on the phone; there was a miscommunication with the operator," Heemeijer
says "I was waiting for an answer on if the doctor was to come, and then
the doctor was here and I was still hanging on the phone!"

This is longest visit of the evening so far. Paques examines the patient
and talks with her as well as with her husband and two sons. After
deciding the woman must go to the hospital, Paques calls an ambulance
and leaves the son in charge.

Of the six patients she's seen tonight, this is the only one she admits
to the hospital. "I do think house calls are very good to have, because
several people are quite ill and unable to come with their own transport
to the GP or hospital," Paques says. "I can still manage to keep them at
home; it's a more comfortable situation for the patient than in the
hospital. And it's a lot less costly for the health care system.

"The cost of an ambulance is already very high and, once you're in a
hospital, you have to do a certain amount of tests which we don't do,"
she says. "Very often you can keep people at home especially if they're
very ill, terminally ill. It's much more patient friendly and better for
your budget."

Meanwhile, back at the clinic, Bartelsman has seen about 30 patients.
Clinic visits are still a lot cheaper than going to the hospital.

"Anxiousness is always a good reason to see someone," Bartelsman says.
"If parents are worried about a sick child, we let them come. If they
have symptoms that haven't been going away, we let them come. If they
have things that we think need to be seen — especially on Friday evening
— it's a long wait until their doctor's are back again on Monday, so
we'd rather see them now than wait till Monday to see their own doctor
when they could have been treated much earlier."

Across the Netherlands, there are about 120 after-hours clinics like New
West. And more than 90 percent of the Dutch population has access to them..

Compare Medical Billshttp://www.npr.org/news/specials/healthcare/healthcare_profiles.html

--
Civis Romanus Sum

The folks who keep screaming the evils of national health care are too
fucking stupid that they are paying thru the yang yang for what is a
given like the fire dept or police dept. When you call them they do
not ask you what kind of fire insurance do you have or the police ask
you how old are you and is it worth their while to help you.
.