The issue of uncompensated care in the U.S is not as bad compared to countries that are in the developing world. However, as a first world nation, it could do a lot more to give the uninsured and those who cannot afford healthcare, the medical care they deserve upon visiting the doctors. According to Kronenfeld et al., uncompensated care refers to the healthcare services that are provided to patients who are usually not able to pay either because of avoidable or voidable circumstances (62). Dranove et al. define the term uncompensated care cost as “the sum of losses on charity care and bad debt” (1472). This is similar to Almgren’s definition, which he says is the care that is classified as charity or bad debt (190). There are two forms of uncompensated care in the healthcare sector. The first is the bad debt kind of uncompensated care is one where a hospital is unable to collect the full amount of a hospital bill that it requests from its patients. The second form is charity, an uncompensated type of care that a hospital provides to its patients without the hospital expecting the patients to make a payment. The question of whether people should be turned away in emergency rooms if they cannot pay for care will always be debatable. Physicians are always confronted with patients who cannot pay for the services they seek and at the same time, it is not all hospitals that can afford to continue treating patients who do not pay for the care. Therefore, the patients and even the physicians will always be concerned with the implication that comes with the type of care that patients receive when they are unable to afford health care services.
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A lot of factors should be put into consideration when deciding which patient deserves to get uncompensated care. However, what is certain is that patients should not be turned away in hospitals because they are unable to pay their medical bills. It is not only because physicians face ethical implications when they terminate the relationship with their patients, but physicians are less likely to encounter any legal difficulties if they provide uncompensated care to patients who are not insured. According to Kronenfeld et al., a report provided by the Congressional research service in the year 2011, found that those who were uninsured in the year 2008, consumed more than $48 billion dollars (151). Based on this report, it is clear that all Americans, whether they are insured or not need some form of health care in their lives. However, there are some critics such as Tanner, an author in the U.S Newspaper who propose that the only way to reduce healthcare is to consume less of it (n.p). The problem with such a suggestion is that it is not likely to work. People may be inactive when it comes to the buying of health care insurance, but they rarely are inactive when it comes to acquiring services in the healthcare sector. There are some instances where the physician is not likely to face any charges from the hospital or the medical board in a state if he or she was to reduce or waive a particular medical fee where the patient is not in a position to pay. However, a physician needs to be careful when making new arrangements for patients who receive or are to receive uncompensated care. When physicians commit technical violations or in instances where they engage in abuse of the patient or fraud, there may be charges brought against them even if they helped a patient by reducing their medical fee. The use of billing adjustments such as waiving the deductibles, under-coding or simply not billing is one of the ways that physicians can get into problems.
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How is uncompensated care paid for if the patient is not able to make the payment? According to Almgren, it is the government that pays for the amount that accrues when a patient walks into an emergency room in the hospital and receives an emergency treatment (190). The government pays with the taxpayer’s money, but there are policy makers that believe the bills that go unpaid in hospitals are usually compensated when some patients who can make the payment in the hospital are charged more. However, that may not happen as often as people may think, since the physicians or doctors are in some circumstances required to show how they arrived at certain sums in a situation where an insured patient is charged more. According to Dranove et al., the Affordable Care Act (ACA) was introduced in the healthcare sector to deal with the growing burden of the uncompensated care costs for the people who would seek medical attention and were not insured (1471). The Act’s coverage helped in reducing the uncompensated care costs from 4.1% to 3.1%, which was a significant decrease for the hospitals involved. There are those with the opinion that tough choices have to be made because, in the end, it will be the people who are the neediest and unable to fight for themselves who will suffer. According to Tanner, healthcare is a commodity and therefore, the uncompensated care should not always be provided at free costs (n.p). This is because the nation would become bankrupt instantly leaving little or no savings in the healthcare. In conclusion, it is the duty of the policymakers to make informed decisions that will benefit everyone or at least a large proportion of all Americans.
- Almgren, Gunnar. Health Care Politics, Policy and Services: A Social Justice Analysis. 2nd ed., Springer Publishing Company, 2012.
- Dranove David, Craig Garthwaite, and Christopher Ody. “Uncompensated Care Decreased at Hospitals in Medicaid Expansion States but Not at Hospitals In Non-Expansion States.” Health Affairs, vol. 35, no.8, 2016, pp.1471-1479.
- Kronenfeld, Jennie, Wendy Parmet, and Mark Zezza. Debates on U.S. Health Care. SAGE, 2012.
- Tanner, Michael. “Not Enough Healthcare to Go Around.” U.S. News & World Report, 2009