WHEN HEALTHCARE IS LIMITED
Treating Charity Patients
Charity or uninsured patients do not receive adequate health care. They cannot afford it as hospitals charge them to four times more than those with healthcare coverage (The Associated Press, 2004). Hospitals explain that the steep charges are meant to cover the increasing costs of indigent care. These patients who are already financially crippled are furthermore subjected to aggressive debt collectors. About 43 million Americans have no health insurance. Insurers typically spent less than $10,000 for a heart attack treatment at a hospital in 2002 as compared to charity patients' incurring an average of $30,000. (The Associated Press).
A Universal Healthcare Suggested
Many hospitals refuse to allow discounts or a negotiation of patients' bills out of fear of violating federal fraud and abuse laws (The Associated Press, 2004). The Health and Human Services Department issued guidelines to help hospitals and other health facilities to accommodate these patients. But heads of these hospitals and facilities explained that they had been trying to cope with the patients and deal with their own financial problems at the same time. They suggested that Congress should enact a universal healthcare to address the problem (The Associated Press).
Nurse practitioners can help balance the widening gap between quality care and cost-efficient care (Luthy et al., 2008). They can provide cost-efficient medical treatment options for specific conditions and by referring them to patient assistance programs. They can also motivate patients to faithfully comply with their plan of care in order to improve overall health and avoid extra costs. Substitutions for prescription drugs may be made for upper respiratory infections, migraine headache, eczema, trichomoniasis, and polycystic ovarian syndrome. These substitutions are amoxicillin in lieu of zithromax for sinusitis; relpax, acetaminophen, ibuprofen or metoclopramide for migraine headache; triamcinolone for eczema; and metformin for polycystic ovarian syndrome (Luthy et al.).
A Bill of Rights for Charity Patients
The Lakeview Action Coalition constituted a Bill of Rights for charity patients jointly with Cook County groups in 2008 (Lakeview, 2011). This Bill provides that every uninsured and underinsured patient has the right to quality health care. He has the right to be treated with dignity and respect. He has the right to clear and accurate information about charity care in his native language. He also has the right to speak, in his native language, with a financial counselor at the hospital. He has the right to apply for charity health care and receive it promptly at the level of care required by his medical condition. He has the right to a simple charity care application process and to personalized assistance for the process. He has the right to freedom from receiving hospital bills and collection calls and contacts while the application process is pending. He has the right to confidentiality. He has the right to access preventative and maintenance care. And the citizens of Cook Country shall hold the hospitals accountable for the fulfillment of their civic duty (Lakeview).
More Medical Residents Volunteer to Treat Charity Patients
More and more medical residents are taking over the task of physicians in treating charity or un-insured patients who cannot pay (Fletcher, 2005). The residents do so under the supervision of physicians. Lately, the residents are doing so more and more, as in the case of clinics in metro Denver. The clinics where they treat the patients receive funding from sponsoring hospitals but they say they are losing money in the process. Residency programs confront financial shortage nationwide, according to the representative of the American Academy of Family Physicians, which has more than 93,000 physician and medical student members nationwide. In the 80s, there were fewer un-insured. Well-paying health plans enabled physicians to subsidize free care. But this capability has recently diminished. This is why the care of the uninsured has been absorbed by residents....
Physicians are generally inclined to refuse their practice to the uninsured or those on Medicare of Medicaid because they might incur debts (Fletcher).
Residency programs at present are the best source of care for low-income patients because they receive federal funding, aimed at subsidizing medical education (Fletcher, 2005). A medical school receives $60,000 per resident per year on the average. But these federal funds have been declining lately, however. The White House's proposed 2006 budget would reduce these from an essential family medicine program, according to the American Academy of Family Physicians. Reduced or loss of funding means fewer or smaller residency programs, faculty members, family physicians and no residency programs. The uninsured who rely on family physicians will ultimately feel the greatest impact. If these family physicians do not make the money to allow them to care for charity patients, they cannot tell how long they can continue extending free care (Fletcher).
A recent survey conducted by the American College of Emergency Physicians found that 72% of all its members have been treating uninsured patients and expected the number of these patients to increase the following year (Online News, 2004). Most of these emergency physicians also said that these patients would likely die prematurely. In response, 57% of them urged the provision for basic health insurance coverage as a priority goal in improving the country's health care system. The U.S. Census Bureau reported in 2003 that almost 44 million people in the United States had no health care coverage of any kind. This number included more than 8 million children. Almost 800,000 of them lived in the State of Washington (Online News).
The New York Academy of Medicine said that approximately 68% of internists in general practice extend charity care to the uninsured (Pope, 2003). These uninsured patients are the internists' patients who have lost health insurance coverage. The care consists of a reduction in charges and/or a payment plan. Internists conduct five times the number of visits health safety-net institutions do as these institutions cannot accommodate the volume of uninsured. This was the finding of the study, entitled "Care for the Uninsured in General Internists' Private Offices. It investigated ACP members nationwide on the level of charity care they provide, the policies used, profiles of uninsured patients, and the internists' view on the care they provide these patients (Pope).
According to the study, 65% of internists surveyed reduced the usual fee, accepted partial payment, billed for later payment or charged nothing (Pope, 2003). Most of the internists applied collection policies on concessions if uninsured patients could not pay the bill. More than 2/3 or 68% created a payment plan and 28% billed for payment. If the patient could not pay, 38% wrote the payment off and 27% arranged for payment through a collection agency. Internists who fully or partly owned their practices were more likely to accommodate patients who had problems paying. Internists said that uninsured patients are not medically indigent but whose loss of job or other circumstance also lost their health insurance. Internists were able to attend adequately to both insured and uninsured patients at 83% and 74% respectively. In comparison, physicians could do so only at 49% of the uninsured as against 91% of the insured. Moreover, physicians could maintain the care of insured at 92% as against only 36% of the uninsured and complete treatments from available resources at 79% of the insured as against only 43% of the uninsured Internists could provide medications to the uninsured or refer them to specialists often or most of the time (Pope, 2003). Almost half or 47% of these patients failed to follow medical advice most of the time or frequently because of the cost involved (Pope).
Surveyed internists pointed to the interplay of current forces as reducing physicians' willingness to accommodate the insured (Pope, 2003). These were market pressures from insurance companies, managed care plans, employers and government payors. When this occurs, the uninsured will have nowhere else to go (Pope).
Other Options for the Uninsured
These are free clinics, charity care and emergency rooms. Free clinics can be found in hundreds of communities throughout the United States (Salamon, 2009). They provide health care to low-income residents and others in need in the locality. They charge reduced rates or extend free care for those in non-emergency conditions. Their reduced charges depend partly on the patient's income. Emergencies should be brought immediately to a hospital. Many staff members in these clinics are volunteer doctors, nurses, dentists and mental health professionals. These clinics may also have and provide access to prescription medications through their partnerships with support entities. They receive very limited government support so they have to raise money through local donations (Salamon).
Charity care or uncompensated health care is provided at reduced cost or for free (Salamon, 2009). A charity or uninsured patient has to apply for this care through a participating hospital or healthcare facility. The applicant cannot be a recipient of government programs like the Medicaid. Many of them have no source of income. There used to be more health professionals who participated in charity care. But financial…
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