Healthcare access and costs for uninsured charity patients

Charity Patients

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).

Literature Review

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).

Cost-Efficient Solutions

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).

Emergency Physicians

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).

Internists

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).

Fewer Specialists Attend to Charity Patients (Galloway, 2006)

As the number of uninsured increase, local specialists willing to treat them become fewer and fewer (Galloway, 2006). These specialist fields are orthopedics, gastroenterology, mental health, dermatology and neurology. Practitioners will not allow patients to come in without an insurance card even if these patients are willing to pay the charges during the visit or through collection. These patients are in many cases the working poor who cannot afford insurance but are quite qualified for government-funded coverage or charity care in hospitals. Thus, the uninsured with allergies or who need a colonoscopy cannot be attended to. They must endure untreated ailments, preventable complication and less appropriate treatments from family physicians who must breach the limits of their scope of practice. The other misfortune is that these family physicians cannot do that so easily. They can only offer drugs without treating the real condition. If they go to a hospital, they are referred back to a specialist (Galloway).

Many of these charity or uninsured patients can secure free or reduced-cost primary care from community health clinics (Galloway, 2006). Then they are referred to specialty care in 3 out of 13 visits on the average. State laws prohibit emergency rooms from turning away patients in life-threatening conditions. Hospitals compensate by not completing treatment. Most of them say they can no longer afford to extend care to the uninsured. State subsidies for reimbursements for indigent care have been cut. Payments for government plans for the poor, like Medicaid, are far less than private rates. Private insurers are paying much more, leading doctors to abandon free care more and more.

Any doctors or clinics, which express willingness to care for the uninsured, are overwhelmed by the number of referrals. And as the cost of insurance increases, employers pay less or ask low-income employees to share the expense. And when doctors and health facilities agree to extend care to charity or uninsured, another problem develops. The patients, who are the working poor, are not always able to complete paperwork or even come to appointments. All these combine and produce the so-called "physician fear factors," which make them reluctant to accommodate the patients (Galloway).

Method

This study uses the descriptive-normative method of research in recording, describing, interpreting, analyzing and comparing relevant information from authoritative and updated sources.

Results and Summary

More than 43 million uninsured Americans have no access to adequate charity health care or pay much more than the insured. State laws have cut down subsidies to indigent care and hospitals and doctors are more and more unwilling to extend free care, particularly in specialty fields. Some cost-efficient solutions include substituting medications, referrals to patient assistant programs and increasing patient motivation to comply with physician instructions. They may also approach medical residents, emergency physicians, internists, free clinics, charity care and emergency rooms.

Recommendations and Research Limitation

These include congressional lobbying for legislations to increase subsidies for indigent health care in health care facilities and a universal healthcare. These should also be the subject of further research. This research is limited to the hospitals and doctors who provided, refused or commented on the adequacy of health care for charity or uninsured patients and cost-effective solutions to current inadequacy of such care in the select hospitals in the current decade. #