Across the nation, hospital emergency rooms in recent years have been facing a multifaceted crisis.

The most obvious burden on hospital ERs is caused by too many people seeking treatment who are either uninsured or underinsured. Because hospitals must provide the care, this trend is adding pressure to most hospitals' already-strained bottom lines.

A related problem for ERs is that many of the people seeking treatment don't need to be in the emergency room. The nature of their ailment is not life threatening or serious in nature. But they come to the hospital because it was cheaper than going to their doctor's office or their doctor's office was closed or they couldn't get a timely appointment with their doctor.

Because the actual cost of treatment in a modern emergency department is estimated to be six times higher than treatment in a doctor's office, this trend is contributing to the overall escalating cost of heath care.

Two developments in community health care are emerging that should ease the pressures on hospital emergency rooms. Both are relatively simple, common-sense solutions. One depends on the generosity of retired health care professionals and the other requires patients to pay something for non-emergency care.

A partial solution to the over-utilization of hospital emergency departments is found in small health clinics designed specifically to treat non-emergency conditions such as ear infections, sore throats, cold or flu symptoms and other minor ailments. Typically staffed by nurses and physician assistants, costs of operating these clinics are much lower than ERs with doctors on staff and sophisticated medical equipment.

Some of the clinics that have been appearing around the country are located in regional grocery stores, in the same ways banks set up small branch offices. In some cases the clinics are in national big-box stores or pharmacy chains. And in other cases, the clinics are free-standing.

The idea of low-cost, walk-in clinics with extended hours that are designed to treat the most common ailments that nevertheless drive many people to their local hospital's emergency department is sensible, and will not only save hospitals money, but will also benefit consumers — and probably make money for their owners.

Steve Case, founder of America Online, sees the potential for such clinics and has invested $500 million in a company involved in the health clinics. Other high profile investors are becoming involved in companies running these clinics.

Another national trend that might soon appear in Butler addresses the issue of ERs having to provide care to the uninsured. Based on a model developed in Hilton Head, S.C., in 1992, the Volunteers in Medicine program involves a community medical clinic staffed largely by retired doctors, nurses and medical technicians who volunteer their services.

The VIM clinics are designed to treat those who are fall into the gaps of the medical safety net — the working poor or those too young for Medicare and too young for CHIP (Children's Health Insurance Program.)

In Butler, a number of retired physicians and nurses are working with Jean Purvis of Penn Township and Ken Bennett, a retired businessman from Slippery Rock to develop a VIM clinic.

In addition to helping the uninsured and working poor, a VIM clinic operating in Butler would also reduce the burden on the emergency department at Butler Memorial Hospital, allowing the hospital to lower its costs — and allowing the ER to focus on actually treating emergencies.

If things go according to plan, a few years from now, Purvis and her group could have a VIM clinic up and running. And, as far as keep non-emergencies out of the ER, market forces coupled with investment opportunities might see store-based health clinics for treating non-emergencies appearing in communities served by Butler Memorial Hospital.

Both the in-store (or free-standing) health clinics and the VIM clinics have the potential to reduce the cost and operating burdens facing the nations hospital emergency rooms. And as such, they present a powerful win-win situation benefiting not only hospitals but the patients they serve.