Hospitals Limiting Indigent Care
Posted by WhiteCoat on August 21, 2008
This study posted on HealthAffairs.org titled “Caught In The Competitive Crossfire: Safety-Net Providers Balance Margin And Mission In A Profit-Driven Health Care Market” gives a good synopsis of how hospitals are trying to survive in a market that is made up of more and more patients who lack insurance and who lack the means to pay for their medical care.
Simple solution: Follow the money. Hospitals are moving out of inner city locations and relocating into affluent suburbs, increasing services in high-profit subspecialties. As a result, access to low-profit care such as mental health, dental care, and vision care were cited as the most difficult to find. In addition, private practice physicians are also decreasing the amount of charity care they provide.
Unintended consequences: Increased demand on “safety net” providers. Longer waits in emergency department waiting rooms. More bad outcomes due to long waits.
When access to care is no longer available at the inner city hospitals, the medical problems of the people living in the inner cities don’t just vanish.
By closing an inner city hospital, stresses suddenly increase on the EMS system and the emergency departments – the “safety nets”. Even fewer resources to care the same number of patients. The penumbra of patients seeking care will just expand to the suburbs.
Indigent patients will quickly find ways to travel to the affluent suburban emergency departments and the waits there will increase. If they cannot find reliable transportation, then they will call the ambulances for their rides.
More emergency department patients, less emergency departments. It is a recipe for disaster.
It is only a matter of time until affluent patients start becoming the next Esmin Green or the next Beatrice Vance.
Count on it.
A couple of other opinions on the Health Affairs article are contained below.
Survival Tactics By Safety Net Providers May Mean Less Free Care – CQ Politics
Safety Net Frays as Hospitals Shift Resources From Poor – WSJ Health Blog
(Hat tip to ACEP’s Emergency Medicine Today newsletter)
igloodoc said
An interesting article (a little older) from ACEP
It is only a matter of time until the wizards of the carpeted section figure out that if you drop medicare/medicaid, it all goes away. EMLATA, hhs, HIPPA, the JC … all of it. And it will be cheaper than chasing the paying patients to the suburbs.
samwrites2 said
White Coat,
Have you ever ranted about how hospitals go after the indigent with their finance or collections departments?
I’ve recently researched one that had hundreds of civil court cases pending against patients. Many of them will find their wages garnished unless they turn to bankruptcy as I did.
How stupid of me to become ill and hospitalized exactly at a time I had no job or health insurance.
-Sam
dr. bean said
Yah, igloodoc, it’s been done. The Attorney Gen of Illinois is suing two hospitals over it.
Yet Another Patient Dies Waiting For Emergency Care « WhiteCoat Rants said
[...] More ED patients, less available EDs, more medical providers getting fed up with practicing emergency medicine. Hospitals trying to stay afloat by limiting care to indigent patients. [...]