Your argument is that on-site ER wait times are an effective deterrant for frivolous ER visits. They aren't: they impose costs on both legitimate and illegitimate visits. That cost is also imposed randomly: currently, your ER wait is luck-of-the-draw.
If you want to solve the ER overcrowding problem, you should do it directly, by adding a surcharge (over and above the one that already exists) for nonessential ER visits. There's no rational reason to force people to sit in a crowded ER waiting room.
Meanwhile, a retail interface to the ER scheduling systems that already exist is more likely to help than hurt overcrowding, because it will route patients to the least crowded ER in their area.
The problem with the surcharge idea (and lots of other market-oriented solutions to health care problems) is that, under our current system, market forces don't really apply in the same way that they apply to, say, items in the grocery store. Very few people going to an ER are paying out of pocket: many don't have insurance[1], and will either not pay for their visit or will negotiate some sort of payment plan at a reduced rate with the hospital. And, of course, those visitors with insurance don't care what the hospital ends up charging their insurance company- that's the whole point of insurance. This is, of course, especially true during emergency or urgent care situations.
[1] To the extent that emergency room overcrowding is due to people without other health care options (i.e., the un- and under-insured) using ERs as their primary care facilities, surcharges really won't help: by definition, these are people who can't pay for medical care... so adding additional surcharges probably won't have much effect on their ER utilization.
The people who are using the ER because they have no other option and who cannot pay out-of-pocket are not at all germane to this startup idea, which is part of my point.
There is no reason at all that our respective agendas about how US healthcare should be run should require me to wait on-site in the hospital, as opposed to in my home at 1AM, or in my hotel room when I get violently ill on a trip.
There will always be cases when people need to use the ER, and there will never be a good reason they shouldn't be able to call ahead for a soft appointment. Everything about the system, from patient routing to triage to hospital staffing, works better with a system like InQuickER in place.
Oh, I absolutely agree with the usefulness of InQuickER!
My argument was only with the idea of using surcharges to deal with overcrowding. The reason that ERs are chronically overcrowded is not (generally speaking) because of people getting ill on trips, being in car accidents, or having ear-infected kids. The reason that ERs are overcrowded is the large number of people for whom ERs serve as primary care facilities.
As you (correctly) pointed out, these people probably wouldn't be using InQuickER-like services anyway, so they're not relevant to the question of whether scheduling systems are helpful or not. I think that scheduling systems lke InQuickER definitely could be helpful to patients that use them, and maybe to the ERs themselves... but also that, depending on the specifics of a given ER's catchment area, they won't have much impact on overall crowded-ness, since that's largely due to a segment of the population that won't be using the scheduling system anyway.
Now, if one could find a way to make these people more likely to use the scheduling system, you might see more of an effect.
Of course, I could be completely wrong- IANDNAIHEOHQE (I am not a doctor nor am I a health economist or healthcare quality expert), and when it comes to health care quality interventions (which is what InQuickER basically is) it is not at all uncommon for things to behave in a counter-intuitive manner. That's why solid evaluation of system outcomes is so important. Hopefully the participating hospitals are keeping a close eye on their utilization statistics... for their sake, I hope that the InQuickER people are insisting on it- being able to show a significant change in in-ER waiting time due to their system would be the single best marketing tool that they could possibly hope for.
Adding to the list of things that I could be completely wrong about, my sense of who InQuickER's users are could be dead wrong. Tyler, what are your user demographics like? Do they mirror those of the hospitals that are using the system?
If you want to solve the ER overcrowding problem, you should do it directly, by adding a surcharge (over and above the one that already exists) for nonessential ER visits. There's no rational reason to force people to sit in a crowded ER waiting room.
Meanwhile, a retail interface to the ER scheduling systems that already exist is more likely to help than hurt overcrowding, because it will route patients to the least crowded ER in their area.