We have the same issues where I work. It is very frustrating. Some days it feels like I am totally unable to do my job because of funding issues dictating how, when, and how often I can see my clients!

you know do to the fact that my fiancés job does not provide health insurance, i have to keep my son and myself covered under the medical card and i have found personally they are paying for less and less. i need serious dental work for myself and they don't cover anesthesia, but i need a surgical procedure. my son can go to see his pediatrician, but insurance won't cover his vaccinations there. i have to take him to the local health department to get his vaccinations. now it seems to me that if you want people to have better health, so that they don't cost the government more money, you'd provide more coverage for those individuals. i think that anyone that owns a business no matter how small, no matter if they work all yr round, no excuses; should have to provide the option of healthcare coverage for their employees and their families! i like my local health department, but seriously why do i have a pediatrician if they don't cover the necessary things that need to be done? i can take my son in to the health department for everything and not have to travel to 2 different places in order to get the services. it's a bit on the silly side!

I think we have enabled and developed a co-dependency for the poor. Yes, there are working poor, but our system has so much 911 abuse, the ambulance services and hospital EDs have become overwhelmed. We give the clients info on free clinics, but most aren't willing to make appts, or wait their turn, and have made the decision to call 911 for their medical care. Granted, free clinics are limited, but these folks are running the risk of death because they won't advocate for themselves, and figure it's not their job to take care of themselves. I know it sounds harsh, but somewhere along the way, gov't going to have to draw a line in the sand, and natural selection will have to take over. As far a Universal Healthcare goes, anyone carrying insurance would not be eligible, and those countries that have it, budget procedures. If you need an operation, wait your turn.

That's half the problem, I don't know that there are any solutions. So many people have gotten to the point where they think this is the way the system works for them so why change? All it really does is drain dollars away from where it could be used more efficiently. If a visit to the ED runs $1500-3000, and an ambulance ride is $550, how many prescriptions could that pay for for a person over the course of a year? The only way to really change the bad behavior is to reward people for good behavior. $1000 dollars on Dec 15th if you haven't been to the ED in the past year, and an account with the primary physician to cover the costs of monthly visits, and patient scripts to be provided in the MD office for the common scripts, for the course of a year. It would still be cheaper than monthly ED visits.

Bare with me I have a few points:

>Ambulances: I feel torn on this one, For example my Grandfather (who recently passed away) had numerous falls and it was quite difficult to get him back to his feet, as he was 6' and 200plus# when my husband was not around to help me. We had to call for help, which was convenient since he lived one block away from a volunteer FD. YET, I felt bad at the same time because I know how it decreases response times (especially in rural areas) because I nearly lost my mother 6 years ago to a gun shot wound to the head during a home invasion. At that point !! SECONDS ARE CRITICAL !!

>ERs: to hear about someone going to the ED for something that is NON-Emergent is just plain aggrivating. I feel as though the general public needs to be "trained" on what is appropriate for the ED, vs Urgent Care, vs what can wait for their PCP.

>PCP: this is a tough one too, because people without insurance will usually wait until "its pretty bad" then go into an Urgent Care, because up until this point there was no PREVENTATIVE CARE. For those who do have insurance or Medi/Medi, it is becoming harder and harder to find FP docs who are accepting new pt's as well as it being "within network". I do agree also that necessary vaccinations should be obtained through the est. Pediatrician. Many people (again especially those without ins) would rather just go to the State Nurse for the vacc. and into an Urgent Care when their kids get sick. Once again to preventative med. nor managed care for possible underlying causes.

>Insurance companies: They now require prior auth for almost everything - this leads to less time for care and more time on the phone, and no guarantee that it will get approved. The costs are going up and the coverage is going down. BUT what a suprise, an HMO CEO made off with an annual salary of like 4mil. This is because they get rewarded for saving the company money by the higher numbers of denial letters they write.
>Im not sure if Universal Health is the answer either, and even if it was, it would take a lifetime for its approval and implimentation nationwide, then its all first come first serve, not necessarily in the order of need (unless a true emergency).
>> I feel a national overhaul of Insurance company standards, an increase in Preventaive Medicine and Education will be our only saving grace......

Funding issues vs client care presents a difficult issue for the nurse and ultimately the doctors and fundamentally the team.

Example many times the patient could be required a medical test and your director might say she has done those test ten times already discourage the doctors from ordering another one.

The nurse then becomes caught in the middle.

Solution: Give the doctor the information regarding the patient and the patients history and he will make that decision. The doctor's decision is the ultimate decision, but he must be given all the facts and they must not be presented in a bias manner.