EMTALA

EMTALA was an act passed by Congress in 1986 which requires hospitals and ambulance services to provide care to anyone needing emergency treatment regardless of citizenship, legal status, and ability to pay. This was created in response to concern that emergency departments were turning away patients because they could not pay. So now all emergency departments are required to do a basic screen of anyone who walks into the ER. In principle, this sounds like a wonderful thing. Everyone should get medical attention, especially for illnesses that can be life-threatening.

Unfortunately, this is an unfunded mandate; there are no reimbursements. As more and more people take advantage of this act (by coming into the ER without any particular problems or with minor symptoms), hospitals have sustained increasing financial costs to the point that they have to shut down their emergency departments. Waits have greatly increased in length, jeopardizing those who do have medical problems. Those without health insurance turn to the emergency department as their primary care because they cannot get health care elsewhere; however, the ER is not a primary care facility. In practice, EMTALA seems to have hurt emergency departments as well as patients requiring those services.

It's a hard line to walk. You can't deny a basic screen for someone who may have a life-threatening illness. After all, that's what emergency departments are for. However, when people start misusing such resources and when such a mandate is unfunded, it creates an incredible strain on resources to the point that the hospitals have to close their ER. I am unsure whether there is a good solution for this problem, but it is certainly something that we should be aware of.