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A Possible Solution to the Delivery of Emergency Care in the United States

November 17, 2016

Matthew Vasey MD


Department of Emergency Medicine, Tampa General Hospital | Teamhealth, an affiliate of University of South Florida

Disclosure: Opinions reflect neither employer nor affiliated institutions, soley those of the author.




The United States healthcare system is a probability based payer system. The cost of the emergency care safety net sub-system has proven to be a financially baffling possibility driven "Hot Potato" event whose financial burden is irrationally tossed among private citizens, insurance companies, hospitals, provider staffing groups and tax payer vis-a-vis medicare / medicaid. The compassionate and reasonable implementation of EMTALA centralized the delivery requirement of emergency care, however its destructive flaw is in that the delivery process and re-imbursement of emergency care has continued on with a non-probability based expectation and in a capitalist economic form. The financial risk of the possibility of emergency care must be centralized.

Upon centralization of this risk, the delivery of emergency care can become a probability driven process by granting providers of emergency care sovereign immunity under the guidelines of EMTALA. The tax payer can then cost effectively cover the risk of a reduced and more cost effective EMTALA safety net. The risk burden of the possibility of emergency care can be best managed centrally through a socialized system of emergency care. The shortcomings of a complete socialized healthcare delivery system will not occur due to the current state of the United States capitalist non-EMTALA based healthcare system. This could serve as a bipartisan stepping stone for improvements in the delivery of healthcare in the United States.

As an independent minded emergency physician and informal student of finance, beyond S&P500 Index based assests I choose not to invest directly in healthcare stocks. As an investor, I would not want my CEO apologizing for making money while as an emergency physician I would not want a company profiting at the expense of my patients. A variety of individual corporate governance subsector shortcomings lead me to believe the only way to optimally lever the fulcrum of the balance sheet equation is through practical government regulation free of conflict of interest on behalf of all American citizens at possible risk of needing emergency care.

Providing emergency physicians the elective hybrid opportunity to serve as Federal EMTALA physician contractors or agents with cost effective tax incentives for affiliated hospitals to credential this physician cohort could initiate a transition towards a risk-optimized systemic delivery of emergency care.

Last updated 11.19.2016





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