Why do patients use emergency rooms rather than primary care?

Good post from the DMCB summarizing a recent study on why patients use emergency rooms rather than primary care for medical treatment, despite the vastly higher costs of emergency room care:

64 hospitalized patients with low socioeconomic status were approached to participate in a "qualitative" research interview (here's one example of how it's done). The patients were selected because they had been hospitalized via the ER multiple times, were between the ages of 18-64 years, were uninsured or on Medicaid, lived in a poor ZIP-code region of the city... 

Two themes emerged:

1) Convenience/Access: Even if they have access to primary care, the emergency room and inpatient setting remains the more convenient option.  That's because walk-in is available 24/7 and all testing as well as specialty care is available during a one-time visit.  Zero dollar primary care co-pays don't make up for the hassle, time and expense of calling ahead for appointments, arranging transportation (even if vouchers through Medicaid are available) or being referred for separate testing as well as specialty consultation.

2) Technology: Based on personal experience with their primary care docs, the emergency rooms and hospitals were perceived to have more technically proficient providers who were better able to achieve the correct diagnosis and render the correct treatment in a timely fashion.

There are more interesting observations in the full blog post.

Where is corruption improving?

Rwanda, Sudan, South Sudan, Azerbaijan, Belgium, Cambodia, Fiji, Georgia, Philippines, Serbia, Taiwan.  

What do these countries have in common? 

They are the only countries where people -- on the whole -- believe that corruption has decreased over the past two years, according to Transparency International's 2013 Global Corruption Perceptions report.  

It is an interesting list, in that there is not much to tie the countries together.  Rwanda, Cambodia, Georgia and the Philippines have experienced very good GDP growth over the past few years.  But GDP fell by 11% in Sudan in 2012 and by 4.5% in 2011.  In South Sudan, GDP supposedly fell by a stunning 55% in 2013.  Meanwhile, Azerbaijan achieved solid, but unspectacular growth over the past two years, and Belgium and Serbia were stagnant.  

These countries range across continents and regions as well.  Rwanda and the Sudans are the only African countries represented.  Belgium is the only OECD country on this list.  No Latin American countries made the list.  

Georgia was likely helped by a surprisingly smooth and peaceful transition of power.