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Thursday, October 26, 2006

Preventive Care, Patient Dumping, and Universal Health Coverage

A few hospitals are starting to recognize that offering free preventive care to some uninsured patients is cost effective because it avoids much higher costs later on. Others hospitals are, apparently, pursuing a different strategy to avoid the cost of caring for the uninsured:

Hospitals Try Free Basic Care for Uninsured, by Erik Eckholm, NY Times: Unable to afford health insurance, Dee Dee Dodd had for years been mixing occasional doctor visits with clumsy efforts to self-manage her insulin-dependent diabetes, getting sicker all the while.

In one 18-month period, Ms. Dodd, 38, was rushed almost monthly to the emergency room, spent weeks in the intensive care unit and accumulated more than $191,000 in unpaid bills. That is when nurses ... tagged her as a ... repeat visitor whose ailments — and expenses — might be curbed with more regular care. The hospital began offering her free primary care through its charity program.

With the number of uninsured people in the United States reaching a record 46.6 million last year, ... Seton is one of a small number of hospital systems around the country to have done the math and acted on it. Officials decided that for many patients with chronic diseases, it would be cheaper to provide free preventive care than to absorb the high cost of repeated emergencies. ... Over the last 18 months, Ms. Dodd’s health has improved, and her medical bills have been cut nearly in half.

Reaching out to uninsured patients, especially those with chronic conditions like diabetes, hypertension, congestive heart failure or asthma, is a recent tactic... These institutions are searching for ways to fend off disease and large debts by bringing uninsured visitors into continuing basic care. ...

Still, only a fraction of the uninsured ... are benefiting. “All these local efforts are commendable, but they are like sticking fingers in the dikes,” Ms. Davis of the Commonwealth Fund said, noting that the larger trend was hospitals’ seeking to avoid the uninsured. ...

Universal care is a solution to this problem and it would also save all the money and effort that is wasted "seeking to avoid the uninsured" by handing them off to someone else:

Police allege 5 patients were dumped on skid row by hospital, by Richard Winton and Cara Mia DiMassa, LA Times: The LAPD says it has opened its first criminal investigation into the dumping of homeless people on skid row after documenting five cases in which ambulances dropped off patients there... Police said the patients, who had been discharged from a Los Angeles hospital, told them they did not want to be taken downtown. ...

Though police have documented other cases of hospitals dropping off recently discharged patients in the district, "this is the most blatant effort yet by a hospital to dump their patients on skid row against their will," LAPD Capt. Andrew Smith said. ... Police said they were investigating whether the patients were falsely imprisoned during their transfer and also whether the hospital violated any laws regarding the treatment of patients. ...

[T]he city attorney is looking at whether hospitals that engage in dumping could be penalized for violating the federal Emergency Medical Transfer and Active Labor Act, which requires medical facilities to screen and stabilize all patients and penalizes them for releasing or transferring patients who are medically unstable.

The city attorney also is examining whether hospitals that dump homeless patients can be cited for violating a state law that deals with unfair business practices...

    Posted by on Thursday, October 26, 2006 at 02:00 AM in Economics, Health Care | Permalink  TrackBack (0)  Comments (18)


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