Greetings!

I am an ER social worker and am working on a program to assist the unisured/ indigent in obtaining health care, while at the same time attempting to re-educate patients concerning inappropriate ER use i.e. coming to the ER repeatedly for non-emergencies which impacts the patient (huge debt) and the community, in that many ER's are being forced to close due to this issue.........Any input is appreciated. Would particularly like to hear from the uninsured on what would help, that can realistically be provided. I have created patient guides to "Simplfying, Streamlining and Organzing Your Life!" that provides resources for most every need along with toll-free/ 24 hour nurse lines, pharmaseutical assistance programs, as well as information on anxiety, stress and getting control of your life. I provide bus tickets for transportaion, set-up doctor appointments, provide supportive counseling and also make up individualized books for people on whatever issues impact their health and healing, most recently a patient with M.S., and someone coping with a divorce....I would also like to institute workshops at the hospital for unisured/ indigent individuals on Health and Self Healing, Personal Empowerment, Taking Back Control of your Life, Finding Work You Love etc.
Input?

The entire problem is tied to just a few things:
Lack of health coverage (a shame in such a country as ours)
Lack of education (Many of the poor do not realize that there are clinics that will charge nothing or next-to-nothing)
Lack of Publc Awareness ( The politicians and general public don't seem to realize that making health care affordable to everyone would cost less than treating the preventable diseases that the poor present at ERs.)

It is certainly true that often the poor use the ER as a doctor appointment/visit for non-emergency need, and use ambulances as taxis. Sometimes it is a lack of education (see above) and sometime it is Hobson's Choice, that or nothing.
Another factor, a smaller one, and dependent upon location, is citizenship status. Many immigrants, legal and illegal, are reluctant, or even afraid, to use what services are available. Fear of strangers who speak a different language is part of that, but more recently, a fear of deportation is a more real threat. Depending on the health problem, this can manifest itself in a much worse scenario. Communicable diseases coupled with the close quarters immigrants (and the poor) often share will cause a rapid spread of what should have been a preventable condition, one easily treated had it been treated early.
The newly-poor, often elderly, sometimes present a similar situation as immigrants. People who once took care of themselves both physically and financially, may now find that their body has betrayed them, and their pension left the country with some CEO. They are now faced with a situation that they never imagined they would be in, and naturally, are afraid, and sometimes ashamed, that they must used what they used to call "the dole." They, like the 'regular' poor, also face another health problem due to poverty - poor nutrition. Mac and cheese goes farther than a can of vegetables, and fresh vegetables are often not found without a bus trip or two, which changes the cost factor. The neighborhood stores and conveience shops charge more in poorer neighborhoods, which adds to the problem. Yes, a bus trip or two takes one to a larger, cheaper market, but one is limited to what one can carry to and from a bus stop, and also onto a bus.

The average, middle class American never thinks about things like this, and doesn't even realize that the poor often face these problems daily.

I realize that I answered none of your questions, but I am hoping that a few people will read my post and start to think about the problem, and how to resolve it.

I appreciate the feedback - you have a very good grasp of the problem...I
I would really like to hear from those of you who have no insurance and are struggling financially, as to what may be a helpful alternative to using the ER for basic medical care? What might an ER social worker due during your visit that would be helpful to you?

I don't know of any "good" alternatives to using the ER for basic medical care. There are free health clinics but many people are not aware they exist or have no means to get there. It would be wonderful if there were volunteer drivers to take patients to and from the health clinics. I don't see that happening anytime soon.

I think helping the uninsured is a government issue. They have the power to make change.There are people with no health care who have no choice but to get medical attention at an ER room. That is reality. The Department of Health can only do so much. The government can help the uninsured through more programs. Employers can help the uninsured by providing quality health care for their workers. You could get into the political aspect of why so many people are uninsured. This only leads to people arguing, placing blame and disagreeing. After a lot of words and breaths, you are still in the same situation as you started. That route is usually a waste of time. It is a sad situation and not one that is easy to fix. Limited resources will only take you so far.

An ER social worker could give the patient a name/phone number listing of free clinics in the area. They could discuss Medicare and Medicaid options with the patients. A listing of government assistance programs would also be helpful. I think one of the best things a social worker can doing during the visit is to listen deeply and answer questions honestly. It is very difficult to be in a situation and many times patients feel alone. Compassion goes a long way.