25 Jan How is Emergency Care Handled Outside the US?
See what EM trends, spending, training, and more is like in the US healthcare system compared to other countries around the world in this quick guide now.
Did you know the United States was one of the first countries to establish emergency medicine as a specialty?
Since so many countries around the world use the US model for their EM training, it’s fairly easy to asses the US healthcare system compared to other countries in the realm of ED wins and fails[*].
And now it may be time for American emergency departments to learn a few lessons from how these countries have improved upon their blueprint.
So in this guide, we’ll compare aspects of the US healthcare system with those in Europe and Asia so you can see how your independent ED group fits in -- or stands out.
The US Healthcare System Compared to Other Countries In Europe
Before we get to other countries across the EU, let’s discuss the UK specifically first.
The UK Healthcare Experience
In 1954, the UK established the National Health Services (NHS) which offers universal healthcare freely to all its citizens.
Despite this universal access, the US still spends more on healthcare than the UK.
Between 2009–2013, the US spent almost 18% of its GDP on healthcare while the UK spent half that amount[*].
However, free healthcare means attending-level physicians in the NHS system earn a basic salary between £37,923 and £70,718 per year, which makes recruiting new EM physicians challenging as many would rather earn more in a general practice with a regular schedule (i.e., no night or weekend shifts)[*].
Plus, not all EM residency programs include training at a level 1 trauma center. This means hospitals and independent ED groups may need to spend extra time and money training new staff.
One major plus to the UK’s healthcare system is their wait times.
EDs in the UK have a “four hour target” window, which gives financial incentives to streamline emergency care so it doesn’t exceed this timeframe.
This four-hour clock starts the moment a patient checks into the ED and ends when they physically check out.
Over 95% of patients across 20 UK EDs are seen and treated within 4 hours thanks to this rule[*].
Now let’s branch out to the rest of the EU.
How US Healthcare Compares to Other Countries in the EU
While the discussion about the health of citizens in the US and EU is a topic for another time, we can compare stats about how emergency medicine is handled across borders using several notable studies[*].
To begin with a big issue, the US has the highest rate of deaths which could be avoided by routine healthcare interventions compared to those in the EU.
Per 100,000 people, the average number of preventable deaths is 70. Here’s how other countries compare:
in the US
In the UK
When citizens don’t have access to preventative services, chronic conditions such as heart disease, asthma, and diabetes cause hospital admission rates to be higher as well.
Which means hospital admissions for preventable diseases are more frequent in the US.
Here’s how the US emergency admission rate for chronic conditions per 100,000 patients compares to other EU countries:
367 cases versus 218 in other countries
103 patients compared to 35 elsewhere
198 vs 144 in the EU
On a positive note, admittance rates for patients with hypertension are lower in the US with just 57 patients per 100,000 compared to 75 in the EU.
Not having treatment options for chronic diseases may come down to not being able to make an appointment with a physician.
Here’s the percentage of patients who can make a same or next-day appointment with a doctor or nurse when they need care:
On average, 19% of patients have to wait six days or more for an appointment.
And the US has longer wait times for appointments when patients are sick than any other EU country. Here’s how many wait six or more days for an appointment:
Since patients in the US have trouble seeing their GP, the use of the emergency department in place of regular doctor visits is more common in the US than in most comparable countries.
The average percentage of patients who visited the ED for a condition which could have been treated by a general physician is 7%.
Check out the percentages of non-emergency cases in:
It’s clear to see why independent ED groups are spending so much time and money on non-urgent ER visits these days -- and why they’re always looking for ways to reduce this number.
But what’s the story of healthcare like in Asia?
The US Healthcare System Compared to other Countries in Asia
EM was first started in Singapore back in 1984. As the speciality grew, doctors, nurses, and students flocked to EM programs in the US and UK for hands-on training and experience.
A comprehensive study on EM trends in Asia shows[*]:
Not all hospitals have emergency departments. The percentage of hospitals able to treat emergency traumas per country is:
Because so few hospitals exist per the large population sizes in Asia, many EDs cannot refuse to treat patients, similar to the US.
In remote parts of Asia, EDs are often patients’ only access to medical care.
But treating every patient comes with longer average wait times for a bed, which can range from five hours to 168 hours, as you can see by country:
8 to 12 Hours
6 to 24 Hours
6 Hours for Private, 24 Hours for Public Hospitals
24 to 48 Hours
Longer wait times not only increase the chances of a condition getting worse, but also increase the number of dissatisfied patients and those who leave without being seen.
Wait times are also affected by the fact that doctors per population rates are very low in Asia.
With more people using EDs, the demand for certified emergency physicians only grows. In Malaysia, Philippines, and Thailand, there’s only one certified emergency physician per 100,000 people.
Nurses are also in high demand in Asia as the proportion of nurses working in the ED ranges from just 1% in Japan to 15% in Philippines. By comparison, Registered Nurses (RNs) are one of the largest healthcare occupations in the US, with employment in over 2.4 million jobs[*].
So How Does Your Independent Emergency Department Compare?
As you can see by these stats, the US healthcare system has a ways to go before being perfect but your ED practice can only improve upon this solid foundation.
Make sure you’re following operations strategies designed to help your independent ED group shorten patient stays, better outcomes, increase patient satisfaction, and generate revenue to rise above some of these less-than-impressive numbers.