Uncompensated medical care in Louisiana: a survey of LSMS members

Physicians have traditionally taken into consideration the financial situations of their individual patients and frequently provide free and/or reduced-fee care to patients in need. An attempt was made to measure this free care in Louisiana through a survey of the active members of the LSMS. The questionnaire contained several sections designed to obtain general information about the physician's practice, care provided to uninsured and indigent patients, donated medical services, Medicare and Medicaid participation status, and policies regarding waiver of copayments and deductibles. For methodology reasons, the data provided by respondents were not generalized to the entire LSMS physician member population. Even with this statistically conservative approach, however, the survey indicated that the 1,086 respondents provided free and reduced-fee care in the amount of $51,353,650 annually, or an average of $47,287 per physician respondent.

State-Aid Cancer Clinics: treatment and follow-up services for indigent patients

State-Aid Cancer Clinics in South Carolina provide outpatient services for medically indigent patients who have a diagnosed cancer or a suspicious Pap smear and who are referred by a physician. The program pays only for outpatient services provided in one of the nine cancer clinic hospitals. Professional services, transportation and inpatient services are not covered. Although program funds are limited, the State-Aid Cancer Clinics served 3,767 patients in FV 1989; 1,104 of these were new patients and 2,663 were for continuing care. The program's operation is dependent upon the interest and support of the medical profession, particularly those physicians who give of their time and talent without pay to treat the medically indigent patients served in the clinics. This truly is a unique partnership in which the public and private sectors share a common goal of reducing unnecessary mortality and morbidity associated with cancer in South Carolina.

The supply of charity services by nonprofit hospitals: motives and market structure

This article studies provision of charity care by private, nonprofit hospitals. We demonstrate that in the absence of large positive income effects on charity care supply, convex preferences for the nonprofit hospital imply crowding out by other private or government hospitals. Extending our model to include impure altruism (rivalry) provides a possible explanation for the previously reported empirical result that both crowding out and income effects on indigent care supply are often weak or insignificant. Empirical analysis of data for hospitals in Maryland provides evidence of rivalry on the supply of charity care.

Report on a seminar on financing and service delivery issues in caring for the medically underserved

Current national activities directed toward improving access to health care and assessing the potential effectiveness of various financing and service delivery strategies were reviewed by an invited group of 39 public and private sector health policy experts. Health care access problems of the medically underserved population were defined and a range of strategies for addressing them were presented. The seminar was held at Columbia, MD, July 6-7, 1988, sponsored jointly by the Robert Wood Johnson Foundation and the Health Resources and Services Administration, PHS.

Exempting the poor: the experience of Thailand

Fee exemption schemes are widely recommended but little analysed. This paper analyses the operation of the Free Medical Care Project in Thailand, which enables those classified as poor to receive free treatment at government facilities. The paper concentrates in particular on the size and geographical distribution of the group eligible for free care, and on the extent to which the geographical distribution of the budget matches the geographical distribution of the poor. By analysing published data available at national level, information is produced on numbers of people eligible for free care, on the numbers who receive free care, and on the geographical distribution of the free medical care budget. Comments are also made on how the project appears to be operating at health facility level. The paper goes on to consider whether the equity effects of the project could be improved by reorganizing the project, and what impact reorganization might have on the costs of the project.

Underinsurance for severe mental illness

Mental health care for the severely mentally ill in the United States is financed by a combination of public and private funds. Both public and private health insurance programs handle mental illness differently than they do other illnesses. This article documents uninsurance and underinsurance for severe mental illness in the United States based on studies conducted during the last decade. The relationship between private insurance and public assistance is analyzed, and major arguments around equality in insurance coverage for severe mental illness are examined. Alternatives for reducing uninsurance and underinsurance for severe mental illness in order to avoid undertreatment are discussed.

Medicaid expansions dodge budget knife; funds will aid hospitals, children, elderly

Although projected healthcare spending took a highly publicized cut overall in the fiscal 1991 budget, the level of some less publicized expansions in Medicaid spending for pregnant women and children was surprising even to their advocates.

Medicare program; Part A. Premium for the uninsured aged for 1991--HCFA. Notice

This notice announces the hospital insurance premium for the uninsured aged for calendar year 1991 under Medicare's hospital insurance program (Part A). The monthly Medicare Part A premium for the 12 months beginning January 1, 1991 for individuals who are not insured under the Social Security or Railroad Retirement Acts and do not otherwise meet the requirements for entitlement to Part A is $177. Section 1818(d) of the Social Security Act specifies the method to be used to determine this amount.

New rules affect bad debt, charity care reporting

Many healthcare organizations must change the way they report patient service revenue, following provisions in the American Institute of Certified Public Accountants' recently revised healthcare audit guide. The guide directs that bad debts should be reported as expenses and that charity care should be excluded from revenue and accounts receivable. As a result, hospital executives must ensure that criteria for differentiating charity care from bad debts are in place, understood, and properly carried out.

McCarthy assesses the issues, looks to future strategy debate

Facts aren't always enough to engender change, but they have helped the AHA make progress in influencing health care policy decisions, according to AHA president Carol McCarthy, PhD. In a speech presented at the AHA's 1990 annual convention in Washington, DC, McCarthy takes stock of the past year's events and how they might affect hospitals.

Access to care: clozapine in the public sector

Clozapine holds great clinical promise for some chronic schizophrenic patients. However, limitations on access to the drug by the largest subgroup who need it, the indigent, are causing frustration for patients, their families, physicians, and public-sector mental health systems. The drug is available only through the manufacturer's proprietary monitoring system; many public-sector professionals and agencies feel that the system is overpriced, is unfairly exclusive, and has thus far kept the drug out of reach of most patients who need it. Arguments that patient improvement will lead to dollar savings in the long run seem overly optimistic. The ethical issue of access to treatment remains. The author discusses these and related issues and reports early experience from several public mental health systems.

Health insurance coverage of Minnesota farm families

This study of 1,482 farm families assesses the extent and cost of health insurance coverage among Minnesota farm families and finds that these families are buying less insurance coverage than urban families, while paying a higher proportion of their income for these premiums. More than three-fourths of the farm families surveyed buy their health insurance plan themselves and pay for it out of pocket. Their plans, on average, are slightly less expensive than employer-provided plans in urban areas, but they provide much less coverage and have more copayments and deductibles. Unlike their urban counterparts, who often choose health plans for convenience of location or freedom to choose physicians, farmers generally choose plans on the basis of costs and services provided. About 7 percent of farm families are without insurance, and many others are underinsured because they cannot afford to purchase an adequate plan.

Care for the underinsured: who should pay?

Inner-city medically underinsured adults describe their preferences for health care and willingness to pay for health care services. The responses of 146 patients attest to the burden of administrative and economic responsibility placed on the public health care sector for indigent patient care. The results of this survey address the information required by the nurse managers who must balance patient needs against administrative pressures to generate revenue from patient fees.

Indigent health care plan for Tennessee

The author describes the development of an Indigent Health Care Program for the State of Tennessee from the campaign pledge of the Governor, through the development of an Indigent Care Cabinet Council, to the development and enactment of appropriate legislation required to implement this program. The program deals with availability of health care services, accessibility to health care services and funding mechanisms. The backbone of the program is the involvement of the local community and the coordinating and networking of the existing private, community and state health care providers.

Who bears the burden of uncompensated hospital care?

This paper considers the question of who bears the burden of uncompensated hospital care. The thesis is that the hospital that provides the services received by indigent patients may not be the one that eventually bears the financial burden. The various sources of funds available for the payment of indigent care are identified and the incidence of financial burden discussed. The paper ends by addressing several considerations that should be taken into account in evaluating how fairly the indigent care burden is distributed.

HIV infection and AIDS: another layer to consider in addressing indigent health care in the United States

This paper will present the current status of the epidemic of HIV infection and AIDS and show relationships to indigent health care. Statistics of disproportionate race and ethnic minorities affected with poverty and HIV infection will be discussed. Projections of who will be affected and estimates of the impact will be included. Community planning in regard to legislative, service, and educational agenda will be suggested.

Case twelve. Positioning a small rural hospital to respond to the requirements of a recently enacted state-wide medically indigent assistance act

The case hospital was required to strategically respond to significant environmental challenges brought into play by the legislative enactment of a new Medically Indigent Assistance Act (MIAA). Publicity surrounding the debate leading up to the passage of the new law by the state legislature placed the hospital under unprecedented scrutiny by local taxpayers, healthcare recipients, elected officials, advocates for the poor and other local providers of healthcare services. This case reports the implementation of a highly desired strategy on the part of the hospital and the necessary roles of multiple stakeholders in the realization of hospital strategy. The case also illustrates the spill-over effects of stakeholder relationships developed in pursuit of particular strategy on the organization's ability to pursue future strategy.

Indigent health care: the increasing contribution of AIDS to the health care budget deficit

With the number of AIDS cases in the United States exceeding 100,000 and rising, it is becoming more of a financial burden to take care of this population. The Regional Medical Center at Memphis, like most hospitals providing indigent care, sustains annually a large deficit for both outpatient and inpatient care of AIDS patients. With the establishment of a dedicated AIDS clinic, it is hoped to maximize outpatient care and the utilization of available financial resources. Implementation of this model may help obviate the financial disaster that is impending for the already overburdened public hospitals and their patients.

Emergency departments need aggressive management

Medicare's prospective pricing system has fostered much cost-consciousness in hospitals regarding inpatient activities. But hospital managers must also examine other activities in search of opportunities to decrease expenses. Managers can minimize the large loss potential in emergency departments by developing detailed protocols and ensuring their consistent application through well-trained employees. This is particularly true for emergency departments having especially acute loss potential because of the volume of care provided to indigents.