Ethical Issues In Health Care

The Emergency Medical Treatment and Active Labor Act (EMTALA) ensures public access to emergency services, meaning stabilization and treatment, regardless of a person’s insurance status and ability to pay. Overall, the purpose of this federal law is to prevent hospitals from discriminating against patients who are uninsured or unable to pay by either refusing to treat the patient, rejecting the patient entirely, or transferring them to a lower quality hospital. Thus, it keeps medical emergency practitioners in check by looking at how they may help the patient rather looking at how much they can get out of the patient. EMTALA does apply in this situation. Further, this situation demonstrates how this act was directly violated. It is the hospital’s

In the early 1980’s there was increased observation by emergency room physicians that patients were being transferred or dumped from private hospitals to public hospitals based on their inability to pay. Concern for the care of the patient was one of the mitigating factors for our nation’s development of Emergency medical treatment and labor act (EMTALA) . Enacted by Congress in 1986, EMTALA was government’s way of ensuring basic screening, stabilization and care for all patients. Non participation with EMTALA was not an option, since the law tied government payments to the institutions. Simply put, if you want Medicare/ Medicaid payments you will abide by this law. EMTALA would not have been needed since there were already safeguards for indigent patients, but they were not followed, rather seen as guidelines. With the backing of EMTALA, patients had better care assurances, and guarantee of non-dismissal. The Joint Commission on Accreditation of Hospitals stated that “individuals shall be accorded impartial access to treatment or accommodations that are available or medically indicated, regardless of race, creed, sex, nationality, or sources of payment for care” It has been strongly inferred that based on the implementation of emtala, increased numbers of uninsured were using the emergency rooms as their primary source of care. The thought was those without insurance, did not seek preventative care through a primary care doctor,

Concern for the care of the patient was one of the mitigating factor for our nation’s development of Emergency medical treatment and labor act (EMTALA) . Enacted by congress in 1986, Emtala was government’s way of ensuring basic screening, stabilization and care for all patients. Non participation with emtala was not an option, since the law tied in government payments to the institutions. Simply put if you want Medicare/ Medicaid payments you will abide by this law. There shouldn’t have been need for emtala since there were already safeguards for indigent patients, but they were not followed, rather seen as guidelines. With the backing of Emtala, patients had better care assurances, and guarantee of not being dismissed. The Joint Commission on Accreditation of Hospitals stated that “individuals shall be accorded impartial access to treatment or accommodations that are available or medically indicated, regardless of race, creed, sex, nationality, or sources of payment for care” It has been strongly inferred that based on the implementation of emtala, increased numbers of uninsured were using the emergency rooms as their primary source of care. The thought was those without insurance, did not seek preventative care through a primary care doctor, as they did not have way to pay for services, but still received treatment through emergency rooms.

A lot of people will not succumb to getting help with their health, as they just cannot afford to pay for the treatments or operations themselves. Thousands of dollars are spent out of their own pockets to allow them the “luxury” of getting good healthcare. Imagine having to decide whether to go ahead with an operation to remove an appendix? For example the average appendectomy costs around $33,000. (Castillo) Heaven forbid a patient needs a heart by-pass surgery. The cost for this without insurance is an average of $117,094 and heart valve replacement cost an average of $164,238. (American Heart Association) Deny a loved one a life-saving surgery or use the money to buy your next

Ozark Medical Center (OMC) in West Plains, Missouri is one of them. It is considered a Disproportionate Share Hospital or ‘DSH’ and provides charity care. As Jennifer Davidson describes it in her Health and Wealth Update story on KSMU, “Charity care is healthcare that isn’t paid for, usually because the patient doesn’t have money or insurance” (p.1). Today the DSH designated hospitals do not receive the same amount of federal funds (DSH payments) they did before the ACA from 2010 was enacted. A supreme court decision in 2012 ruled the forced Medicaid expansion, which was included in the ACA, unconstitutional for all states and as a result the expansion is now an option for the states. However, Jennifer Davidson explains that when the remaining parts of the ACA were passed, “it included a 75 percent cut in those DSH payments. That’s because another part – the Medicaid expansion part – was supposed to make up for that reduction. So: more people covered by Medicaid, less charity care – and less need for DSH payments” (p.1). There are also cuts in the ACA to Medicare payments, which in addition to the reduced DSH payments could affect a hospitals finances by a large percentage. In Jennifer Davidson’s story, Ozarks Medical Center’s CEO David Zechman explained that “OMC could see a 60% reduction in its bottom line if Medicaid doesn’t get expanded”. OMC is not the only small rural hospital in Missouri which sees

It has been estimated that about 43 million Americans are living without health insurance (msnbc.com). This means that $43 million Americans are quietly going sick to avoid paying harsh hospital bills. The only question that one can ask is, why? Why are so many of our children and elderly going sick without care or cures? The answer is fear. Fear of harsh treatment and unfair, hiked hospital bills. In 2004, MSNBC stated that financial experts told lawmakers that hospitals normally charged uninsured patients up to four time mores that they charge insured patients. This can possibly be due to the fact that uninsured patients don’t have advocates to argue health care bills like insured patients do. Therefore, to compensate for their lost profits on insured patients, doctors over charge the people that can’t afford it the most. In addition to those that over charge customers without insurance, other health care facilities require them to pre-pay for the costs of their treatments and diagnoses. Uninsured Americans are usually those without adequate finances to pay for medical insurance plans; therefore, overcharging and pre-charging these helpless people should be an illegal act.

In Alameda County, California a woman without insurance arrived at a private hospital agonizing in labor pains. The hospital turned her away because their computer proved she wasn’t financially able to afford their care. A few hours later the woman’s baby was still-born in a county hospital. A year later in San Bernardino, California a doctor at a private hospital deemed a man who had been stabbed in the chest stable and recommended him to a public county medical center where the man later suffered cardiac arrest and died (Scu.edu). These patients weren’t denied for medical reasons, but for purely economic reasons. The hospitals feared that these people would not make for good business because they could not pay for the treatments. Instead

Hospitals are therefore not provided in areas where their rendered services may not be ‘needed’ or properly compensated for. According to law, a hospital cannot turn down an uninsured patient during emergency.

The lack of health insurance reached began to become a serious issue in the mid-1990’s reaching a crisis level in the 2000’s. Individuals without insurance turned to emergency rooms across the country to obtain care routine care, turning emergency departments into primary care facilities. In many instances, people who presented at emergency rooms for treatment could not be turned away due to various health and safety regulations; therefore, patients were seen without the ability to pay often leaving the hospitals with millions of dollars in uncollectable debt, subsequently leading to the insolvency of hundreds of hospitals across the United States.

Healthcare is a very important asset that people need to have. The possibility of accidents, illnesses, and other occurrences resulting in needed hospital care is high and these things happen every day. Many people in these circumstances can’t get the treatment they need because they are denied access by healthcare providers. Many treatments and medications that people need in order to stay healthy or become healthy are very expensive and some people cannot pay for those medications all on their own, which is one service provided by healthcare insurance. According

When it comes to patients, patients commit fraud and abuse insurers and subsidized federal programs to obtain preventable services, payments, and medical procedures. Private insurers play their role in fraud and abuse by subsidizing federal programs in order to dishonor medical claims and keep away from financial responsibility for essential medical services. Increased costs of fraud and abuse results in increased insurance premiums, taxes, and costs for medical treatment.

Non-Profit hospitals can often assist potential patients to care for the uninsured in their community (Kovner & Knickman, 2008).

Everyday individuals who are lucky enough can go to a hospital and receive help. However in some places help is limited if finances are. Money is power and without money individuals are left to face health care with what they have in their pocket. Insurance companies may help customers with financial coverage for things such as health care. However this is only to a certain degree. Once individuals come to realization that their insurance companies cannot help them come up with sufficient funding for their treatments or procedures the hospital will only obligately stabilize the individual until money is included in the process. Hospitals are frequent offenders for fraud. Hospital professionals may choose to work together with insurance companies or they may commit fraud by upscaling coding costs. In John Q (2002). the truth is revealed to John. By the doctors purposely neglecting to disclose or propose information about extra testing to along side HMO. The hospital also gains a surplus of revenue by failing to mention low cost preventable procedures in exchange for a annual bonus and later more profitable surgeries that insurance companies will not cover. In conclusion hospitals are frequently perceived as a helping hand in society but are truly driven by power and money and are committing white collar crimes

When an individual walks into a hospital seeking care, they are asked many questions prior to being admitted. Some of these questions are basic, such as name and address, which have minimal effect on care received. However, before the doctor has even seen the individual, one of the questions asked often determines the type of care received: what type of health insurance do you have, if any. Often times, patients are turned away from hospitals because of lack of insurance with a favorable reimbursement rate for the hospital like Medicaid or lack of insurance completely (Young, 2009, 124). Like almost everything else in the world, health care is driven by profits. Therefore, a patient without insurance is deemed as unfavorable by a hospital and

The ethical right for individuals to have access to health care already has a form of legal binding within the United States as seen in the Emergency Medical Treatment and Active Labor Act. “In 1986, Congress passed the Emergency Medical Treatment and Active Labor Act (EMTALA), which forbids Medicare-participating hospitals from “dumping” patients out of emergency departments” (Pozgar, 2010, p. 221). The act provides that: