<p>I’d hate to interrupt the flow of the other thread on ebola, even though this is a related topic, so I will start a different one</p>
<p>Perhaps it is in poor taste to ask this question, given his recent death, but I was part of a very interesting discussion about it at lunch today and thought CC may also have thoughts to share. Co-workers had a wide variety of thoughts and opinions…</p>
<p>Who will pay for the care Mr. Duncan received? </p>
<p>He was a Liberian citizen, presumably without insurance in this country. Apparently some European countries offer virtually free health care to travelers but that’s obviously not the case here. Will his family be expected to pay? Don’t believe Presby is a ‘county’ hospital, rather a private one–Does that change the picture?</p>
<p>Just heard CNN report the family is unhappy with the care he received. Are lawsuits plausible? Someone suggested that he should have been airlifted to Atlanta or Omaha to facilities with experience in fighting ebola. I doubt that my insurance would cover such an expense…that would have to come out of pocket, I suppose.</p>
<p>Interesting thought that may lead to this thread being closed, as such controversial issues do. </p>
<p>I am not an expert in this, but EMTALA laws forbid hospitals from turning anyone who needs emergency care away for lack of insurance. The origin of this law, I believe, is that once a pregnant woman in labor was turned away and there were complications. </p>
<p>So, I assume that Mr. Duncan was admitted and received care on the basis that he was seriously ill and it was an emergency. Where he came from, or if he had insurance, would not have been part of the decision. Mr. Duncan is not the only patient that has no way of paying that hospitals treat. </p>
<p>It is now the hospital’s problem to recover the expense of taking care of him. However, a hospital is a business and it has ways of recuperating its losses by raising costs of other expenses on paying patients, reducing staff so that it reduces expenses overall. There are so many ways to do this that it is impossible to know exactly how it will recover the costs, but it will. I assume that the hospital budget allows for a certain number of these kinds of admission a year and has budgeted for it. </p>
<p>So the answer is that many people will “pay” for this event, but there probably isn’t a better choice. It would seem draconian for hospitals to refuse to treat emergency cases. As to the family being unhappy, anyone can sue if they can find a lawyer willing to take the case, or pay the lawyer up front. It doesn’t sound like they can do that, so a lawyer usually doesn’t take a case like this without having a good chance at winning, since his/her payment would be part of a settlement. </p>
<p>Of course a lawsuit is plausible, until it is thrown out.</p>
<p>The hospital basically said “hwhoops, our electronic medical record system was at fault” when it should have been the nurse’s responsibility to make sure the doctor was aware of the man’s travel history.</p>
<p>It is illegal for hospitals to turn away extremely sick people, and most, even private hospitals, have public statements about charity care posted frequently throughout their halls.</p>
<p>And yes, he is by no means the only person without insurance.</p>
<p>I am sure they would start to go after his family for the money.</p>
<p>Yes, I know that hospitals are obligated to render emergency care. But the criticism I’m hearing now, implies that hospitals are expected to bend over backwards to seek out and pay for unproven therapies and unapproved experimental drugs for uninsured patients. Geez, it’s not like any place in the US maintains stocks of blood from recovered ebola patient, ready for transfusion. </p>
<p>This may seem a terribly crass statement, but Duncan dying after 10 days is probably a better financial outcome for the hospital than if he had recovered and remained quarantined in the hospital for yet another 2-3 weeks.</p>
<p>Who will pay? The taxpayers of Texas. You can’t and shouldn’t turn away a critical patient regardless of their ability to pay. But the hospital will go to the government to help defray the cost of this stay. And in the long run the costs for other things will go up to cover the cost of the services that are not reimbursed. Who do you think pays for medicaid now? Who do you think pays when the uninsured and illegals flood the ER’s with no intention of paying? Everyone else. </p>
<p>Don’t be fooled, hospitals are not rolling in dough. They are fighting everything they have to keep their doors open and looking at every way under the sun to lower expenses. </p>
<p>I can assure you that the uninsured pay plenty of medical bills. For one thing, although <em>hospitals</em> may choose to classify a person as charity care, <em>doctors</em> often do not. Neither do labs. Our family has paid plenty of those bills.</p>
<p>In Duncan’s case, obviously he does not have an survivors who are liable for his debts.</p>
<p>Is there a specific state run insurance pool for those who can’t pay in Texas? I believe some states may have this, but not all. In many states, as described above, the hospital eats the cost, and then recoups it via higher fees for all other patients. Uninsured patients who have any assets get hit the worst, as insurance companies often negotiate lower prices for their members; but the guy off the street has no leverage, and may pay many times the cost of what an insurance company would pay. But this is not new just for this patient – it has been happening for many years with many types of emergency cases, this guy is just a high profile case.</p>
<p>But really… does anyone think the hospital should have turned this patient away, or released him at any time during his stay? He was in the US legally for a visit from what I understand, can’t see how he could have been deported (and they sure couldn’t put him on a commercial airline!).</p>
<p>Well, given that he was a public health threat on a grand scale, I doubt anyone would think that. </p>
<p>But if he had something that would have only affected him, there probably are plenty of people who would have no problem saying “Kick him to the curb.”</p>
<p>What’s different about Duncan’s case than, say, illegal immigrant birth tourism, is that our gov’t has declared that ebola is “a top national security priority”. Duncan was being treated/quarantined in the hospital as much for the safety/security of the public as for his own well being. </p>
<p>In contrast to Duncan throwing up on a sidewalk, a pregnant woman giving birth on a sidewalk does not pose a national security threat. </p>
<p>Not an expert, just remembering from an ACA thread eons ago, but I think Texas has a special tax assessment that goes to charity care in each region of the state. Maybe someone from Texas can confirm. </p>
<p>But a disease like ebola could seriously (and quickly) bankrupt any chairty care money bucket.
I feel for this hospital. They cared for a men who arrived most likely without insurance and they offered him care - private room and all that is very expensive. Now, they have to spend more money on lawyers to defend themselves. This is just wrong. </p>
<p>If he came here on a visa, the person who is considered to be the host could be on the hook for the expenses of the visitor, depending on the type of the affidavit of support the US sponsor filed for Mr. Duncan.</p>
<p>It’s irrelevant. His family doesn’t have any money. And, the people everyone calls his family are not related to him in any way. He had a 20-year old son with the woman but they were never married and he hadn’t seen the child since he was 3 years old. And, she said the reason he hadn’t visited before apart from the Visa problem and that they had a big fight in the 90’s was that he didn’t have the money for a plane ticket. After they sue the hospital perhaps there will be some money. It’s an interesting question though, because they are complaining high and low about not getting this and that. Well, I don’t think any of us would get the all the fancy treatments for whatever if we just wandered into an ER with no way to pay. Maybe, I’'m wrong.</p>
<p>I don’t know Texas, I only know my state that does have such an agreement between the state and hospitals. While some uninsured pay their bills, in my experience if I see an uninsured claim come through my office I know 95% of them will not pay. There is no family to go after. Most likely the hospital will eat this one.</p>