(Mint Press) – In the United States, emergency medical care is guaranteed under the law. The Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986 requires non-military, Medicare-receiving hospitals to admit and treat anyone with any immediate threat-to-life, regardless of ability to pay. The law also prohibits hospitals from stopping care once started or transferring patients to other facilities due to financial concerns.
The penalty for violations to this law can be in excess of $50,000 per incident.
In light of this requirement to serve everyone that needs immediate help and the financial burden such an obligation can force on a hospital, many hospitals have implemented procedures to limit the hospital’s burden for care. Some, such as the Mayo Clinic, limited enrollment of new Medicare and Medicaid patients.
Others, have engaged in “patient dumping,” or the illegal turning away of emergency patients due to lack of insurance or means to pay — while others have used more insidious methods to filter out non-payers.
As reported by Times, “As a growing number of hospitals struggle under a glut of unpaid bills, they are turning to companies like Accretive. To win promised savings, all hospitals have to do is turn over the management of their front-line staffing — ranging from patient registration to scheduling and billing — and their back-office collection activities. Accretive says it has such arrangements with some of the country’s largest hospital systems to help reduce their costs.”
Paying upfront for care
Accretive Health is a debt collector. The organization works with dozens of American hospitals, including Minnesota’s Fairview Health Services and North Memorial Health Care. One of Accretive’s roles is to secure upfront payments or a credit card or check before emergency care is provided for uninsured patients.
The University of Minnesota Medical Center in Minneapolis was in danger of losing its Medicare and Medicaid certification due to its affiliation with Accretive. Minnesota Attorney General Lori Swanson has filed a report stating that Accretive pressed bedridden patients for payment and was threatened with the denial of emergency services if the patient didn’t settle previous debts or pay in advance. One woman sought treatment for a possible heart attack and was asked to pay $672 upfront.
According to the Star-Tribune, “Federal inspection documents obtained by the Star Tribune show that the hospital repeatedly violated government rules by subjecting patients and their relatives to ‘abuse and harassment’ during bill-collection attempts in the emergency room, labor and delivery area and other wards.”
Accretive has agreed to leave Minnesota for six years and settle a lawsuit with the attorney general for $2.5 million.
Nashville-based HCA, the nation’s largest chain of hospitals, has demanded upfront fees before medical care will be administered, in violation of EMTALA. “It has been a successful part of helping to reduce crowding in emergency rooms and to encourage appropriate use of scarce resources,” HCA spokesman Ed Fishbough said. Almost half of all hospitals nationwide charge an upfront fee, some as high as $350.
This is causing poor or budget-restrained patients to walk away from getting needed care. “It seems the point of the policy is to put a financial barrier between the patient and care,” said Anthony Wright, executive director of Health Access California, a consumer advocacy group.
HCA argues that the policy is in place to discourage non-emergency use of emergency services and that HCA screens and stabilizes anyone with an emergency, per federal regulations. According to the company, of the 5 percent, or 314,000, of all emergency room visits that were ruled to not be an emergency, about 230,000 paid and remained in the emergency room for treatment. The remaining 80,000 left.
“This is a real problem,” said Dr. David Seaberg, president of the American College of Emergency Physicians, who estimated that 2 to 7 percent of patients screened in ERs and found not to have serious problems are admitted to hospitals within 24 hours.
The cost of medical care
The problem lies with the immense cost of providing health care in the United States.
In the United States, a person spends on average of $8,233 a year on health care. This is two and a half times more than most people in the developed world pay. The United States healthcare system is 17.6 percent of the nation’s gross domestic product (GDP). A hospital stay costs on average more than $18,000. The average cost among the developed nations is $6,200.
In comparison, the United States Armed Forces — the largest standing military in the world — constitute 4.7 percent of the country’s GDP.
For the 17 cents on every dollar that Americans spend on health care, as reported by the Organization for Economic Co-operation and Development (OCED), the U.S. has 2.4 practicing physicians per 1,000 people in 2010 — below the OCED average of 3.1 and below the rate of most developed nations. The number of hospital beds are 0.8 below the rate of 3.4 beds per 1,000 people, and life expectancy at birth is six years less than that in Japan and two years less than the average.
The United States is the leader in health care research and cancer treatment; a large percentage of health care funding is spent on medical research and disease analysis. Five-year cancer survival rates are higher than most OCED-participating nations, and the colorectal cancer survival rate is among the best in the world.
However, the cost spent to treat specific diseases is raising the cost of health care in general, promoting the detriment of the general health of the nation. Countries, such as France and Japan, have found success in controlling their health care expenses by utilizing a common fee schedule, so that health services, doctors and hospitals are paid similar rates — regardless of if the patient has insurance or not. In doing this, rates must be adjusted to accommodate non-insured patients.
Under the current system, health care providers have the right to choose patients for routine care who have insurance policies that pay generously to those that don’t, such as Medicaid patients.
In addition, the health care systems in most ODEC-nations are flexible, so that they can easily respond to areas of expanding need and adjust accordingly, such as lowering rates and fees in that area to permit more enrollees. In the United States, limits are typically statutory for Medicaid and Medicare and cannot be changed without consent of Congress. This rigidity makes it impossible to contain and control cost.
Mark Pearson, the head of the Division on Health Policy at OCED told PBS’ Newshour, “Spending on almost every area of health care is higher in the United States than in other countries. For example, nearly $900 per person per year goes on administrative costs. This is far higher than in, say, France, which spends $300 per person, but which also has a system in which health care services are reimbursed in a similar way to the U.S.”
“In part, higher costs are also because the U.S. has been slow to embrace the advantages of information and communications technology in improving the administration of its system and in cutting down on waste,” Pearson added. “In Sweden, for example, all drug prescribing is done electronically — a message is sent directly from the doctor’s office to the pharmacy. Not only does this cut down on medical errors, it is also thought to save 1-2 hours of work by the pharmacists per day.”