Should it be done for the price of a paramedic? Not if the price justifies more care. We've already discussed that two medics and an E450 ambulance is pricier than a nurse, NP/PA, or even a physician in a Toyota Corolla.
Yes, that is true, but it is not so easily compared. When you have 2 medics and an ambulance and you add other resources, it is not cheaper.
I wouldn't say the medic model really has the goal of adding care, but primarily to reduce the needfor emergency care, thereby lowering call volumes. That is where the money is saved, not earned.
It basically gives already existing response persons work to do when not responding to prevent calls and thereby allow for less response resources.
I think home healthcare (from all disciplines) is absolutely vital for effective primary care. But as I said, the current primary care system in the US doesn't work, and other countries who use the same model are seeing it stressed or ineffective.
Medical practice must evolve with society in order to maintain value, it doesn't.
The success of CPs seems grand if you go with, for example, the ECAD program of "Free CP visits. Free. FREE! CALL US WHENEVER! REALLY! NO CHARGE!" But is that viable?
Depends...
It will not be self supporting. The money will likely have to come from some form of tax somewhere.
However, not charging a patient for any medical service out of pocket maintains that person's wealth. Which maintains the maximum level of independance without additional support. That prevents asset liquidation for medical care, reatains large assets like homes, which can be passed on to family and friends, so their productive years grow wealth instead of needing to replace it. Wealthy societies require less medicine. It is an interesting economic circle.
In the short and direct term, is having a paramedic or two that on down time drives around installing fall precautions, making sure medications are refilled, and the patient understands and is taking them correctly (the later being a core nursing role currently unfulfilled except for a minority of peopl who "qualify" for this.) cheaper?
An example I like to use, paramedic A knows there is an elderly lady in his response area. (it is always a lady cause the men die years before) This medic has been to the house many times, the lady cannot reliably go to appointments, get to the store, etc. Perhaps she has live in family, perhaps not, doesn't matter.
So once a month she goes into acute CHF exacerbation. This known, baseline, call volume adds the need for more ambulances in the area. (costs $) The ALS ambulance to the ED, ICU admit, and day or two in the ward. (costs a lot of $)
How much would be saved having the paramedic and partner stop by during lower call volumes and maybe bring her $3 of lasix with them. Not that they prescribed, but are simply picking up from the pharmacy like any other friend or family memeber. (thousands of $ a month on 1 person)
Let's say you just plan to liquidate her lifetime middle class assets. (much greater than poor or working poor) put her in an SNF, and she lives 20 more years. Her assets will never cover that cost. In a healthcare environment, she will be sick more often, additional treatment and costs. Over those 20 years, even spending everything she has, somebody (aka tax payers) will be on the hook for 10's of thousands if not 100's of thousands.
Leaving her family to work to reproduce such assets from 0, when they are elderly, this cycle of heavy $ loss repeats.
If her family were wealthier, they would get sick less often, lss severe, maybe have money for healthy food, less destructive outlets (drinking and smoking) and time to exercise. Further reducing healthcare expenditure over time. (it is not individual, once these people are out of the workforce, they become medicare/medicade) when that is an MI at 50 or COPD at 50 instead of osteoporosis at 80 or 90, you add decades of tax funded healthcare costs.
Does free community paramedicine sound more viable?
It certainly does to me.
Of course RN, midlevel, and physician as a mobile community health provider would each offer a (variable) increase in level of care at increasing cost. What makes sense?
Yes it would. to the immediate population, and as I said, ultimately I think to maintain value to society.
But the short term reality is that it is simply too expensive to implement.
I think having all of those providers in the program makes sense! My BSN RN/midlevel/physician in a Toyota is reality:
It happens all over the world.
The thing is though that the VA system is seperate from the overall US system and operates under different rules, with a different population, and a different economic reality. It is not part of the general healthcare market.
The general healthcare market in the US would benefit from many of the VA ways of doing things. But somebody would have to pay. Additionally, there are many very wealthy and powerful competing interests who stand to lose a lot if those changes are implemented. They will not go down without a fight for their life.
