Clerks Control Healthcare Access for Uninsured Patients

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Source: University of Illinois at Chicago Released: Tue

11-May-2004, 06:00 ET

Clerks Control Healthcare Access for Uninsured Patients

Description

With no requirement for healthcare providers to care for uninsured patients

seeking routine medical attention, frontline staff -- from clerks to

insurance verifiers -- are the gatekeepers, deciding who is seen by the

physician and who is turned away, according to research.

With no requirement for healthcare providers to care for uninsured patients

seeking routine medical attention, frontline staff -- from clerks to

insurance verifiers -- are the gatekeepers, deciding who is seen by the

physician and who is turned away, according to research conducted at the

University of Illinois at Chicago.

" Nonmedical personnel play a significant role in decisions affecting access

to care for indigent patients, " said Dr. Saul Weiner, assistant professor of

medicine and pediatrics at the University of Illinois at Chicago College of

Medicine, and lead author on the study.

Published in Medical Care, a leading journal in healthcare studies, the

study found that at three medical centers in the Chicago area (one for

profit, one not-for-profit and one a public institution), policies were

ambiguous about what to do when uninsured patients cannot afford required

prepayments. As a consequence, low-level personnel who are not trained in

decision-making end up making discretionary choices, particularly when the

organizations' priorities conflict.

Seventy-one percent of the staff Weiner and his colleagues interviewed

reported that they did not turn patients away. The remainder said that they

did so on occasion.

" Each year, millions of uninsured individuals in the United States seek

routine healthcare services that they cannot afford, " Weiner said. " While

the Emergency Medical Treatment and Active Labor Act requires service in

emergency rooms, no such law governs non-emergency care. "

" The goal of the study was to examine the role of front-desk clerks at large

urban medical centers who are charged not only with their employers' mission

of caring for those in need, but also securing payment -- goals that clearly

conflict when the patient is indigent. "

At the three medical institutions, Weiner said, policies were incomplete,

inapplicable, or had not been circulated among the frontline staff. For

example, at one site, the policy required the clerk to request 50 percent of

the cost of service if the patient was unable to pay the balance in full.

However, it gave no guidance on what to do if the patient couldn't afford

even the 50 percent.

Those kinds of ambiguities left decisions on healthcare access to the

front-desk staff.

These staff were often advocates for indigent patients, going out of their

way to argue that a patient should be admitted or classifying the case as

" insurance pending " rather than " self-pay. " In fact, Weiner found, none of

the clerical staff at the lowest level of the pay scale reported ever having

turned a patient away. These individuals also tended to be those who were

sympathetic with the patients' plight -- some of them having previously been

uninsured themselves.

By contrast, 39 percent of the more senior admitting staff (supervisors who

are responsible for controlling costs and ensuring payment and who have less

patient contact) said they had at times denied access to care, doing so for

pragmatic reasons and with regret.

" The data suggest that decisions about access to healthcare are the product

of a network of unwritten rules and understandings and the preferences of

staff as they interface with individuals who are attempting to become or

remain clients of a reluctant bureaucracy, " Weiner wrote in his study.

" If this approach is widespread, then concerns arise about whether patients

who are getting care are, in fact, those with the highest need or, rather,

those best able to negotiate within such a system. "

Co-authors of the study were Margaret LaPorte, in the UIC College of Urban

Planning and Public Affairs, Dr. Abrams, at the Rush University

Medical Center, Dr. Arthur Moswin, at Reese Hospital, and

Warnecke, in the UIC School of Public Health.

The study was funded by The Wood Foundation, the nation's

largest philanthropy devoted exclusively to health and healthcare.

For more information about the UIC College of Medicine, visit

http://www.uic.edu/depts/mcam/.