Another Viewpoint on the Uninsured
Last week, ADVANCE blogger Janey Goude talked about health care and the uninsured. What she had to say was very interesting, as were the comments that followed. Rather than adding to that discussion I decided to post my comments in my blog because I am going in another direction. The hospital where I work treats a high percentage of uninsured patients. As a result, I work with that population on a regular basis.
First, no one is going to let the uninsured died. Short of EMS refusing to bring them to the ER, no one is going to stop our medical personnel from saving their lives. We don't keep them out of ICU. We don't deny them medications or therapy. We keep them alive even without reimbursement. That's what hospitals do.
To me, the real question is what do we do with the uninsured once we save their lives? What do we do when they no longer require life-sustaining care? We can't kick them out onto the street. We can't discharge someone unless there is a safe discharge plan in place that includes adequate care and continuation of medical treatment if needed. Medicine can be expensive. Few facilities will accept patients for therapy without some form of funding. Add to that the sense of entitlement some patients have and a serious problem emerges.
Our rehab unit accepts patients without insurance. Those patients actually receive better care than their insured counterparts. Insured patients are discharged as soon as insurance refuses to pay, even if therapy goals are unmet. Uninsured patients generally have a longer length of stay because getting them home is more difficult. Sometimes no one is willing to stay home and care for the patient. Other times it takes longer to get co-morbid medical conditions such as diabetes and hypertension under control. In any circumstance, it takes longer to set up charity or reduced-cost services for them after they leave.
There is an old saying that you can lead a horse to water but you can't make him drink. The same is true of patients. You can lead them to medical care but you can't make them be compliant. I've worked with patients who have become frequent fliers because their medical conditions are out of control. We provide them with discounted medicine, DME, therapy and supplies. They come back because they choose to spend their money elsewhere.
Increasing reimbursement to hospitals is a stopgap measure at best. There will always be more uninsured than there is funding. And the money for that funding has to come from someone else. Until we reverse the trend of decision-making without concern for consequences, we'll never solve this problem. Decreasing the number of uninsured requiring non-life-threatening health care is the only way to stem the problem. Providing alternative sources of health care is a step in the right direction but it presumes the uninsured will utilize those alternatives. People who place more value on drugs, cigarettes and alcohol aren't likely to see the usefulness of preventive health care.
I don't have an answer. Nor do I think there is any one right answer. Solving the problem requires approaching it from both the reimbursement end and the utilization end. Meanwhile, health care providers will continue to treat the uninsured without discrimination. Those of us in the trenches deal with the patients, not the problem itself.