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Toni Talks about PT Today

Another Viewpoint on the Uninsured

Published October 4, 2011 3:28 PM by Toni Patt

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.

2 comments

Toni,

I was hoping you'd add to this discussion.  I think you summed it up well in your last sentence.  Dean also hit on it in his "Remember the Pinto!" post.  

The real problem.

No one is dealing with the real problem.  Everyone busies themselves addressing the issues created by the problem, because to face the actual problem is too hard and feels inhumane.  We are willing to be unfair to the multitude so we don't have to put ourselves in the uncomfortable position of holding the few accountable for their irresponsible, and sometimes illegal, actions.

Janey Goude October 15, 2011 8:25 PM

Well said! I don't know if you saw my 2nd post in Janey's piece, it was a link to an article in this past Sunday's NY Times about a patient much like you describe. A man without insurance who was kept in hospital for over a year. What do we do about them? It is understandable that those with insurance resent those without when, as you say, they often receive better care than people with insurance.

I applaud your facility for its generous approach to the uninsured.  I sincerely hope it will be able to continue to do so in a time when philanthropists are in short supply. There still has to be enough money coming in to fund your salary, the electric bill and everything else the hospital needs to function. I agree, the money will have to come from someone else. The question is "Who?"

Thanks for contributing to this important discussion.

Dean Metz October 4, 2011 3:49 PM

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