Only in the sense you can’t get blood out of a turnip. They have to provide treatment to all comers. If you have no money, well, there’s no money to collect. That doesn’t mean they won’t try - they will send bills, make phone calls, and, if they find out you lied and DO have money, there might even be wage garnishment. You can’t just show up and say “I have no money but you still have to give me care, suckas!” and not expect a bill of some sort. It’s just that for those who can’t pay they stop trying to collect at some point.
Right, nobody will OFFER you free stuff. None of it is free, it’s just that if someone really doesn’t have money they can’t collect for the bills.
There’s not some evil cabal of shifty-eye accountants in the back room issuing big scary bills, no. The bill you get is based on the care received - usually the doctors’ time, the nurses and other staff time, any supplies used, etc. Some complaints require more expenditures than others. Broken bones, for example, require x-rays and casting materials. A heart attack requires EKG’s and a tech for the machine, plus various medications. Anyone who goes to an ER can request a detailed bill listing all of this stuff and how much it costs.
And yes, the various items DO have a relatively high price. That’s because in the ER the emphasis is on fast, single dose, and sterile. Just as paying for 1 or 2 Tylenol in a convenience packet at the 7/11 costs more per unit than getting a bottle of 100 pills at WalMart, the separate packing for the items in the ER cost more than if everything was in bulk - but it has to be done that way given the nature of where they are. There are additional labor costs in keeping every bay in the ER properly stocked, but it has to be done because if someone is dying the doctors and nurses can’t take the time to search for stuff, it has to be THERE. ER’s also tend more towards chaos - flying blood and stuff in injury cases, projectile vomiting in others, and so on, which makes keeping things clean more of a challenge and more costly. Security is required, particularly in big cities with crowded ER’s because emotions can run high and people - both patients and those with them - can get out of hand. For all of these reasons, and probably some I haven’t thought of, costs in the ER will be higher than in other areas of a hospital simply because that’s how reality works.
Because a small clinic is a much more controlled environment with less chaos, where some supplies can be purchased in bulk rather than individually wrapped for sanitation, where not every room has to be kept 100% stocked 24/7, they don’t required security guards (usually), they don’t have to pay for a night shift, and the really catastrophic stuff they send to the ER (which is what should go to the ER) rather than trying to treat it on site. People are far less likely to bleed out and leave pools of blood, or vomit copious amounts, and otherwise generate cleaning up nightmares (again, that stuff gets sent to the ER). Most of the docs at a clinic are generalists - ER’s have specialists of all types on call which are more expensive as a general rule. Clinics might have an x-ray or two, but they usually don’t have MRI’s or PET machines, which are wonderful but really, really expensive.
In short, clinics are cheaper to run because the environment is more controlled, and they send the sickest/most expensive patients to the hospital or ER.
You say that like it’s a bad thing - someone has to pay for the lights, water, oxygen, band aids, janitors, etc. required to run an ER. Actually, hospitals invariably lose money on ER’s because, despite the large bills sent to patients, they cost more to run than they bring in.
Actually, it’s private insurance that pays the most towards ER’s. There are also charitable donations and government grants to hospitals, but the government reimbursement rate for ER treatment is, in fact, below cost for virtually all procedures. In other words, no ER is getting rich by treating the poor and billing the government - if an ER’s patients all fell under Medicaid and Medicare the ER would bleed money.
I’ve been to ER’s (as both patient and concerned relative/friend) where only a generalist was needed and other times when no one knew what the hell was going on and you get a parade of specialists tromping through, all of whom will want to be paid for their time and trouble.
That’s part of the issue with ER’s - you can’t state what a “typical” case is, really, because you get everything from the common cold to limbs ripped off and burn cases arriving with steam still coming off them and exotic diseases picked up on adventure vacations and bog-standard heart attacks and sprained ankles - they have to treat anything and everything. My doctor friends have told me about industrial accidents where someone comes in impaled or wrapped around machine parts and you’ve got docs tying to do medical stuff while guys from hospital facilities are wielding saws to cut the non-organic bits away from people at the same time. You get all kinds of crazy stuff happening, it all has to be dealt with on the fly, and it all has to be paid for after the fact.
Because an ER is required by law to evaluate all comers. ALL of them. There usually isn’t a free clinic next door because the “free” clinics, as already noted, can’t make enough money to stay open even with lower costs. ER’s MUST treat anything life-threatening, and they usually treat anything serious, and in many cases, because the people working in them actually DO give a damn, they’ll do whatever they can to help the indigent even if that, strictly speaking, isn’t cost effective on the balance sheet.
Not so much that as they know that, no matter what, the ER cannot turn them away. A clinic may well have criteria and if you don’t meet it they won’t help you - but an ER takes everyone.