In an excellent and thorough review of the rise of and problems with free-standing ER’s, Barry Shlachter exposes to the public a problem that has been known to medicine for some time. (See: “As ERs’ business grows, so does backlash”)
A historical point that should be brought to light is that this has been caused by the payers being “penny wise and pound foolish.”
Through a long course of under-valuing the work of primary care physicians they have driven Marcus Welby almost to extinction.
When patients can’t find a physician, or their physician is overwhelmed and can’t see them in a timely manner, they go to a clinic where they are not well known, where tests already recently done might be duplicated, and where some or all of the services may be “out of network.”
The increased costs are well-illustrated in the Shlachter piece, but the root cause from the payers should be noted.