If you've ever gotten seriously ill or had an injury over the weekend, chances are good that you went to the emergency room and waited a very long time for treatment. There are a few reasons for this--among them, the fact that lots of uninsured people end up using the ER for primary care. But another reason is the lack of alternatives. Relatively few physicians in private practice have late or weekend office hours.
Peter Orszag, the former Budget Director who now writes for the New York Times, would like to see physicians provide more weekend and evening coverage--and not simply because it will make life easier for the patients:
It’s never good to be hospitalized, but you really don’t want to be hospitalized on a weekend. There are fewer doctors around, and people admitted on Saturdays and Sundays fare relatively poorly.
One study in 2007 found, for example, that for every 1,000 patients suffering heart attacks who were admitted to a hospital on a weekend, there were 9 to 10 more deaths than in a comparable group of patients admitted on a weekday. The weekend patients were less likely to quickly receive the invasive procedures they needed — like coronary artery bypass grafts or cardiac catheterization.
It’s not just a safety issue but, for less life-threatening medical problems, also a matter of convenience. Wouldn’t it be nice to be able to schedule your elective surgery on a Saturday if you wanted? Most hospitals don’t offer that option.
And then there are the economics of a $750 billion-a-year industry letting its capacity sit idle a quarter or more of the time. If hospitals were in constant use, costs would fall as expensive assets like operating rooms and imaging equipment were used more fully. And if the workflow at existing hospitals was spread more evenly over the entire week, patients could more often enjoy the privacy of single-bed rooms.
I happen to think this is one area in which market forces can go a long way towards fixing the problem: After-hours urgent care seems like a great business opportunity and I've certainly seen more urgent care centers popping up around the country. That said, government can also encourage this development with financial incentives, like boosting what Medicare and Medicaid pay for primary care (which the Affordable Care Act does very modestly).
Government can also work with professional societies to create coverage networks for after-hours care, which is what the Netherlands has done. Not coincidentally, in a 2007 Commonwealth Fund survey, just 12 percent of Dutch respondents said they found "very difficult" to get after-hours care without going to the ER. That was the best of the countries surveyed. And the worst? The U.S. (in a tie with Canada) at 38 percent.