Given the recent changes in health care services and settings, it can be confusing to know where to "enter" the health care system - where to go to get just the right amount of care needed. Where you go is often determined by what's available in the community or how the service will be paid for "out of your pocket" or by an insurance company.
Ideally, people enter the health care system at the lowest level that can adequately treat them. For example, for treatment of the flu, you would go to a primary care doctor, not to a pulmonary doctor (a physician who specializes in treating lung diseases). This is the idea behind "managed care."
In managed care, health care is managed by a primary care provider (a family practice doctor, a pediatrician or perhaps, a nurse practitioner) who helps determine when additional health care services are needed - when to see a specialist, when to go to the emergency room, when to be admitted to the hospital. Primary care is at a lower level and cost than is specialty care. Specialty care is at a lower level and cost than inpatient care. By getting care in the lowest level setting, costs are kept lower. Cost is an important factor. Emergency room (ER) care is expensive. The costs of running an ER include 24-hour staffing with highly trained doctors and nurses and technicians and expensive diagnostic and treatment equipment. Many insurance companies will no longer pay for a visit to the emergency room unless it is an absolute emergency. They wouldn't pay for an earache to be treated in an emergency room, for example. But what about people who have no insurance and cannot afford a private doctor in a community that has no public health clinic? They will probably end up in the emergency room for care that could have been provided in a doctor's office or a clinic.
Timing is another important factor. Ideally, people would practice good preventive care, have recommended health screenings and see a doctor regularly to catch illness early. This could avoid unnecessary hospitalizations and trips to the ER or to specialists. Sometimes the "system" isn't set up to help people use it - there may not be a doctor's office open after the factory closes in the afternoon. There may not be a doctor or clinic available in the community, so people put off going for care until their symptoms become an emergency.
Teacher Tip: Note that at students' age, parents would make needed health care arrangements. However, students need to begin to understand how the health care system works and when and how to use it. Students may also be the only people available to help someone in an emergency situation; they must be able to recognize an emergency situation and know how to respond appropriately.