Will financial desperation force changes in local government procedure and policy

The San Diego Union-Tribune has a great series, "Health Care 911" (plus "A Costly Cycle of Care") about "frequent flyers," the frequent consumers of emergency medical services. These clients go in and out of the system, and consume a disproportionate share of the resources. In San Diego, 1,136 frequent users, less than 1% of the city's population, generate 17% of the emergency calls, which cost about $20 million annually.

The response is to provide the right kinds of services to these clients so that they can escape the recurring cycle of health emergencies. It can start with providing housing, and then other services.

This type of initiative is in place in many communities (including DC). The idea behind it was discussed in "Million Dollar Murray," a 2006 article in New Yorker Magazine. Basically, the cost of "not doing something" is far greater than stepping in. Murray in Reno was the "one million dollar" man because they estimated that over a 10 year period, that's how much was spent providing emergency services related to his chronic drinking.

A 2004 article from the Seattle Times, "Seattle may extend alcohol-sale limits to much larger area," lays out justifications for single sales bans on alcoholic beverages, again because of the disproportionate negative impacts generated by a few.

It seems counterintuitive, and some people get upset at "giving" social services ("rewards") to people who don't "deserve" the help because their behavior is what causes their problems, but it is a big cost-saver.

As budgets shrink, more local governments are going to have to be innovative and transform how they run policy and practice, in order to be cost-effective.

Interesting, the Union-Tribune series points out that it's more advantageous to hospitals to not address root issues for these types of extra-needy clients because they get more money.

From "Rebuilding lives reduces strains on ERs: Innovative attempt to help some frequent users change their lives holds promise — and faces challenges":

Hospitals receive more than $11 billion in federal Medicaid funding annually to care for low-income and uninsured patients, including frequent users. The money comes from what are called Disproportionate Share Hospital payments, or DSH funds, meant to offset the costs of treating such patients. Instead, critics say, they have evolved into a precious funding stream.

“It’s the difference between losing money and making money,” said Gerald Kominski, director of the UCLA Center for Health Policy Research, who believes the disproportionate share system has financially rewarded hospitals to provide repeat care.