You feel an uncomfortable pressure, squeezing the center of your chest. The pain spreads to your shoulders, your neck and then your arms. As you begin to perspire, you are suddenly overwhelmed with lightheadedness and nausea. You are having a heart attack and you need to find help soon.
If you were living in San Diego and called 911, you may soon be able to receive improved care. San Diego has proposed creating a 911 system which would direct paramedics to rush severe heart attack patients only to hospitals which specialize in heart care (“Beating the Clock” San Diego Union Tribune). This is especially important for STEMI (ST segment elevation myocardial infarction) heart attacks which are the most severe. The city already has a similiar system set up for trauma patients–those who are acutely injured by violence or collisions.
A heart attack is an event where economic markets either fail or do not work optimally. Due to the nature of the diseases, patients do not have time to shop for physician or hospital quality. Allowing only certain hospitals to respond to these 911 heart attack emergencies will be an efficiency improvement since these hospitals will be able to specialize in the STEMI and other heart attack procedures. Dating back to Adam Smith’s Wealth of Nations, economists have realized that specialization is the key to improved efficiency and quality; the hope is the San Diego system will lead to improved health outcomes for its patients.
It is interesting to note that San Diego’s Kaiser Permanente hospital will not be part of the proposed system since they have not invested in the needed catheterization labs. Most other small hospitals wish to preform the procedures since they receive between $55,000 and $175,000 per patient. Is this because HMOs have an incentive to under-provide care to their plan members?