American Hospitals Let The Uninsured Die?

Factual Questions
21

Realistically ER do withhold service. When I was a young thing, I answered the phones in the ER and a lot of the service is “directed” we’d call it. For instance the ambulance driver would be diverted when the called in from a bad area where don’t have the insurance or a lot of poverty. We’d push into standby for lesser emergencies. We were a trauma center, so if a heart attack victim came we’d divert them simply “balance” the system, cause a heart attack can be handled by almost all ERs.

And we would also ship rapidly too. If a person came in with a knife wound, he’d be stablized extremely fast and shipped to the county hospital.

As for Hill Barton, that was a good act but in reality it is worth nothing. What that basically says is a hospital will provide so much free service in exchange for indigent patients…

Now when’s the last time in a major city a new hospital was built, as in NYC, Chgo or Philly or Boston. These were done probably in the 60s or earlier. The Hill Barton commitment was usually for 25 years. Some hospitals have it in perpituity. But still all Hill Barton says is you have to provide “SO MUCH” free care, the distribution is left to the hospital.

So let’s say thru Hill Barton the hospital has to provide 1 million a year. Now remember in the 50s and 60s when these hospitals were built that was a lot of money but it isn’t now for people with major problems. So the hospital can provide all it’s free service from January 1 of the current year and by the middle of the month used up ALL it’s required money and be done with their charity care under Hill Barton. Or they can apply $100 toward each patients bill and do that till the 1 million is used up.

Like everything there is the law and how it’s applied and it’s not done fairly but if you do not have insurance you can bet after you’re stabalized you’re last on the list.

22

How about extortion at minimum

23

Adding anecdote to data, my family members and I have been involved in far too many ER visits. In * every * single * case * that was a real emergency, the scenario was urgent care first and foremost. If another family member was available to handle paperwork and insurance issues, fine. If not, these matters waited until later.

The idea that a person whose life is endangered would not be treated until payment issues were settled is B.S.

If you’re talking about non-life-threatening situations, perceptions can be misleading. Many folks are not aware of the practicalities of triage. If you’ve got a broken leg, but are not bleeding much, you may sit & wait for a significant period of time if there others in the ER who need care immediately in order to survive. It’s easy for an uninsured person to *believe * that he/she is kept waiting because of money issues.

24

Even at that, he was getting treated without insurance- he would be stabilized so that he wouldn’t die, then transported to the county hospital for further treatment.

I don’t see the problem. It’s not like they were going to turn him away, or otherwise not treat him at all and let him die if he didn’t have any insurance.

The issue here is the racism that would make the doctor assume that the man had no insurance.

25

Now I can’t speak for everywhere in the U.S., I’d be shocked to hear of that happening on a regular basis. In the Denver Metro area, we can only be diverted if the hospital is not accepting any ambulance patients at all. In addition, it just generally doesn’t work like that anymore. We work to route patients to appropriate hospitals- obviously trauma patients go to trauma centers. Heart attack patients will go to hospitals with interventional cath labs, and so on. And don’t call us ambulance drivers.

St. Urho
Paramedic

26

OK, senior ambulance guidance technicians. Happy now? :rolleyes:

:smack:

27

It is likely true that continuing care during recovery from trauma is not consistently as good for the uninsured in the U.S. But immediate trauma care is probably as good or better for the uninsured. The hospitals that see the most trauma cases (i.e. urban and inner city) and have a higher percentage of uninsured patients generally have the most experienced personnel, and will do a better job than outlying facilities that have less exposure to trauma and a patient base with greater insurance coverage.

xiix, how does this compare to emergency care access in China?

A front-page story in today’s Wall St. Journal details the increasingly vast gulf between care for the poor and wealthy in China, and overexpenditures for profitable drugs instead of preventive care (over half of China’s spending on health care reportedly is for drugs, compared to something like 10% in the U.S.).

From a recent BBC article, which among other things describes patients bribing doctors to get proper care as “commonplace”:

"Since 1980, government spending dropped from 36% of all healthcare expenditure to 17%, while patients’ out-of-pocket spending rocketed up from 20% to 59%.With low subsidies, hospitals need to find other ways to cover their costs…

Hu Weimin knows their strategies all too well. He is a cardiovascular doctor turned whistleblower, who publicised his hospital’s regulations showing how it made money from patients.

At his hospital, in Hunan province, doctors and their departments got a percentage payment from every prescription they wrote. So the more medicine doctors prescribed, the more they earned…“There are many examples of chasing profit, such as ordering unnecessary test for a patient,” Dr Hu told the BBC.

“For example, if someone has a cold, giving them a CT scan. One media report said a girl had 108 tests for an appendectomy, including an Aids test. Moreover the cost of medicine has doubled, tripled or worse by the time it reaches the patients.”

Dr Hu was unwilling to speak about his own experience in detail. He had been beaten after exposing his hospital’s charging system, and his family have moved elsewhere, fearful for their safety."

Are these problems typical, and do they get debated in China?

28

Well, to be fair, that’d be a sweet job – ambulance driver. But you’re going to pay some guy $12 per hour just on the off chance that he may have to drive an ambulance? No, you screw the paramedic instead, and make him the ambulance driver. So his point is that he’s a paramedic.

Although St. Urho, to be fair, you’re just an ambulance driver when you’re driving the ambulance ;).

29

Anecdotal but pertinent (IMHO):
In October I was involved in a fairly serious motorcycle accident resulting in many injuries. (Went down on the highway at about 70 mph and slid for about 200 feet)
I was taken to the closest hospital, a private one by chance. There I was treated right away for all my injuries including the ones that were not necessarily life threatening. (Mostly road rash)

It was not until after they had finished and I was sitting in the ER waiting for the pain killers to kick in that anyone even come in to collect my insurance information.

Incidentally the way I was dressed and the fact that many people already have preconceptions about motorcycle riders would have at least hinted that I may not have been insured. As it is I am but the Doctors, Nurses and Paramedics who did a fantastic job patching me up had no way of knowing.

30

It could be worse. When I was a little kid, I commonly saw ambulances with the name of the local funeral parlor painted on the side of the ambulance. I don’t think they had paramedics at that time. That scared me.

“Hey Mister, this isn’t the way to the hospital…”

“Don’t worry, we’re just saving you an extra trip.”

:eek:

31

My son burned his finger very badly (I can’t remember which degree) and had to get a small skin graft. We had insurance, but very bad insurance: It required us to pay 40 percent of costs.

We quickly reached the $7500/year maximum (insurance paid almost $100,000 by my calculations) and felt both happy not to have to pay the full cost and overwhelmed by the prospect of trying to pay what we did owe. (We were, and still are, just grad students scraping by on tiny stipends.)

I called the hospital about it, and said I was not really clear on how I could possibly pay it. The lady I spoke with immediately, no questions asked, brought the amount we owed down to $2500. That was more like something we could afford using our credit card.

So anyway, the hospital did get the vast majority of the money from our insurance, so this wasn’t like a total write-off for them. But I was pleased to see that they were willing to work with us so easily. It happened so easily and naturally, I now think that it is likely that hospitals will do things like this quite generally.

Don’t know exactly what it would have been like if I had not insurance for him, though.

-Kris

32

I will just chime in to say that I hope that the “ambulance driver” joke makers are never in need of being driven around in an ambulance.

33

Why is that? They would get the same care anyone else would. 'Medics and EMTs have the same ethical mandates as the rest of of the medical profession

34

OK Shirley. ducks

As an aside, I got to interview the EMTs at Texas A&M University when I worked for the Battalion (if anyone cares, I’ll dig up a link to the article), and I was highly impressed with those guys. To be an EMT at Texas A&M, you have to fit a number of requirements:

  1. Have all the proper certifications for your job (IIRC, this ranged from Dispatcher up through two or three grades of Paramedic, and there is a student organization on campus that provides such training for students who are interested)

  2. Be willing to work 12 hour shifts at the A.P. Beutel Health Center (AKA “The Quack Shack” basically waiting around for someone to need help, as well as working at sporting events and such.

  3. Work for free (the only payment they got was free lunch while they were on duty, and maybe they got to keep the cool coveralls)

  4. They had to be a Full Time student at Texas A&M with passing grades. This is the part that blew my mind, that these guys went through the training, worked the long shifts, and STILL Had to take 12 hours or more of classes and do well in them just to get the priviledge. My hat comes off to those guys (and of course, to paramedics, Corpsmen, and all the various at-a-moment’s-notice lifesavers out there).

Basically, if you were a student at Texas A&M, any assistance you recieved from the paramedics was free of charge (or, more accurately, you had already paid for them along with all 45,000 of your best friends when you paid your tuition and fees at the beginning of the semester), anyone else would get a bill after the fact. Since there was no ER on campus, the ambulance would pretty much just take you to one of the three big hospitals nearby (Scott and White on University and Highway 6, College Station Medical Center on Rock Prairie, or Saint Joe’s on 29th Street in Bryan, all very impressive looking hospitals)

Actually, on an even more tangential note, I was amused to find out that Randolph Air Force Base, in San Antonio, Texas, lacks both an ER and city-legal ambulances. If you have a medical emergency, they pick you up in their ambulance, race you to the main gate, and then hand you off to a city ambulance which takes you to wherever.

35

Well, I will only speak for my own experience, but we don’t ask or accept insurance information until treatment is complete in my ER. Back when we had a county hospital Medical would request transfer to it if the pt was stable for transport, but we would admit to our hosp frequently. We take our compliance with anti-dumping legislation very seriously where I work.

36

Yeah, 'cause all I do is drive the ambulance. I don’t have training in advanced airway managment, cardiology, splinting, venous access, and other treaments and assessments.

:stuck_out_tongue:

37

oh, I wasn’t questioning the amount of care they would receive (I don’t think the EMT guys run to your computer and check if you have ever posted against them before letting you in their ambulance). It was more on the lines of eating a whopper of humble pie, or feeling paranoid all the way to the hospital or that kind of stuff.

38

Yeah, those guys are pretty dedicated, if a bit on the dorky side. A buddy of mine was one when I was in school ('91-'96), and once he got involved with them, we didn’t really see much of him because it ate so much of his time.

Really? I’d have figured they’d take you to Wilford Hall… it is the largest Air Force medical facility, and it’s in San Antonio. And… between it and Brooks Army Medical center, they take about 50% of the city’s emergency ambulance trips.

http://www.whmc.af.mil/about_us.asp

39

Another data point:

My sib had a heart attack on Christmas Eve. He has no insurance and essentially no money either. He was treated at and admitted to the local private hospital then released 3 days later. He was re-admitted a week after that for four days. I’m pretty sure he paid nothing. He was referred to the local county hospital for further testing, but has so far refused to go and get it done.