Editorials

A novel Rx for rising health care costs

Solano County is part of a statewide pilot project to use paramedics for hospital followup, hospice care and other health care in areas where primary care doctors are in short supply.
Solano County is part of a statewide pilot project to use paramedics for hospital followup, hospice care and other health care in areas where primary care doctors are in short supply. Sacramento Bee file

California’s health care system suffers from many problems, but two in particular conspire to drive up costs and reduce access to care, especially in low-income communities.

One is a shortage of primary care doctors. With the federal Affordable Care Act giving public or private health insurance to millions of Californians for the first time, it’s getting more and more difficult for many to find a doctor who will take them as a patient.

The other, related problem is the overuse of emergency rooms and hospitals by patients who could be seen in more appropriate and often less expensive places, or even do fine in their homes if they had the right care.

That’s why a pilot project to expand the role of paramedics in California is so intriguing. It could cut costs and relieve doctors and hospitals of work that could and should be done by others.

Historically, state law limited paramedics to pretty much one role: responding to 911 calls and taking people to the closest available emergency room. But any paramedic will tell you that too many of the calls they get are from repeat patients for the same illness or ailment, who call 911 essentially to get a ride to the ER.

Last year, state regulators wisely took note of this problem and authorized a dozen experiments around California in which paramedics will be allowed to expand the scope of their work.

In some communities, paramedics will follow up with people who are discharged from a hospital after suffering complications from a chronic disease. The paramedics will do house calls to check on the patients and try to ensure that they are following doctors’ recommendations to stay healthy.

In a handful of places, the paramedics will help evaluate whether a patient calling 911 might be treated better outside the emergency room – perhaps in a mental hospital – either by them or by someone else. Elsewhere, paramedics will focus on hospice patients in crisis or on people diagnosed with tuberculosis.

No agencies in the Sacramento region will take part in the pilot project, though Solano, Stanislaus and Butte counties will each conduct pilots; the tests will unfold in Northern and Southern California, on the coast and inland. The paramedics who participate will undergo extensive training for their new roles, and an independent institute at UC San Francisco will closely monitor the rollout.

One thing the monitors should watch for is whether the project truly serves the needs of patients or becomes a way for insurance companies to deny needed care to people who actually should be seeing a doctor.

A final report is due in the summer of 2017.

We expect and hope that this experiment will be a success and, once completed, will be expanded statewide. This kind of help for the state’s beleaguered health care system can’t come soon enough.

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