New York City Hopes to Ease Strain on Its Emergency Rooms

| Wall Street Journal

The country’s largest public-hospital system is about to tackle one of health care’s biggest challenges: getting patients out of emergency rooms and into the offices of primary-care doctors.

What has been touted by New York City Mayor Bill de Blasio as “literally universal” health care guaranteed to all New Yorkers is more technically an expanded primary-care system for the most needy.

Called NYC Care, it is planned to have the typical perks familiar to people who have insurance: a membership card, 24/7 on-call service, easier access to specialists and ready appointments with the same primary-care physician.

Mitchell Katz, the chief executive and president of the city’s $8 billion NYC Health + Hospitals system, calls NYC Care “a population health drive.”

“We are going to make New York City healthier by focusing on primary care,” he said.

The program—which isn’t insurance—will cost about $100 million a year and begin Aug. 1 in the Bronx, with other boroughs to follow. It is expected to serve roughly 300,000 people who are ineligible for insurance, including undocumented and poor people.

New Yorkers, regardless of ability to pay, have long been universally able to receive emergency and preventive care at one of the 11 hospitals and numerous clinics that are part of the city’s sprawling hospital system.

But how patients receive that care, how long they wait for it and whether that care is continuous is questionable. Rolling out a program that people want to use and changing negative perceptions about the quality of care through the city’s safety-net system are significant challenges, say experts.

Another hurdle is whether the new program can live up to the idea of universal health care, said Bill Hammond, a health-care analyst at the Empire Center, a conservative-leaning New York think tank. New Yorkers already had universal access, he said; the problem is how it is used. Health officials are rightly “trying to fix the delivery system,” said Mr. Hammond; meanwhile, the mayor, “made it sound like they’re fixing the coverage system.”

Weaning people from use of the emergency department remains a substantial issue.

It is extraordinarily difficult to change patient patterns of behavior, said Michael Sparer, chair of the Department of Health Policy and Management at the Mailman School of Public Health at Columbia University. “It’s kind of a cliché, but it is true: the hard thing is to make what you might consider the right choice, the easy choice” for patients, he said.

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