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Patient dumping
Patient dumping or homeless dumping is the practice of hospitals and emergency services releasing homeless or indigent patients to public hospitals or onto the streets instead of transferring them to a homeless shelter or retaining them. These cases usually require expensive medical care with minimal government reimbursement. The term "homeless dumping" has been used since the late 19th century and resurfaced throughout the 20th century alongside legislation and policy changes aimed at addressing the issue. Studies of the issue indicate mixed results from the United States' policy interventions and propose a variety of ideas to remedy the problem.
The term "patient dumping" was first mentioned in several New York Times articles published in the late 1870s that described the practice of private New York hospitals transporting poor and sickly patients by horse-drawn ambulance to Bellevue Hospital, the city's preeminent public facility. The jarring ride and lack of stabilized care typically resulted in death of the patient and outrage of the public. Scholars report that private hospital administrations were motivated by a desire to keep mortality rates and costs down when they advised ambulance drivers to send poor patients in critical condition directly to public hospitals like Bellevue even if a private hospital was closer.
After the deaths associated with patient dumping or patient transfer added up, the first attempt at legislative reform in the United States was pushed through the New York Senate around 1907, largely by Julius Harburger. That legislation penalized private hospitals when they sent ill patients away or obligated staff to transfer them to another hospital. Notwithstanding the passage of city ordinances prohibiting the practice, it continued.
The practice of patient dumping continued for several decades, and in the 1960s, it was brought back into the public eye by the media, but not much was done to resolve the issue. Many homeless people who have mental health problems can no longer find a place in a psychiatric hospital because of the trend towards mental health deinstitutionalization from the 1960s onwards. It continues to this day especially in New York City, where Bellevue receives a large share of Manhattan's indigent population.
"Patient dumping" resurfaced in the 1980s, nationwide, with private hospitals refusing to examine or treat the poor and uninsured in the emergency departments (ED) and transferring them to public hospitals for further care and treatment. In 1987, 33 complaints of patient dumping were made to the United States Department of Health and Human Services, and the following year 1988, 185 complaints were made. Since private hospitals ceased publishing their mortality rates, analysts pointed to high costs of dealing with Medicaid's reimbursements and uninsured patients as the motivation.
This refusal of care resulted in patient deaths and public outcry culminating with the passage of a federal anti-patient dumping law in 1986 known as the Emergency Medical Treatment and Active Labor Act (EMTALA). In 1985 the Consolidated Omnibus Budget Reconciliation Act (COBRA) was passed that was meant to regulate how patients were transferred and also end patient dumping. COBRA was not a complete solution, and in the years after its passage, hospitals struggled with creating appropriate discharge protocols and the cost of providing health care for homeless patients.
Statistically, Texas and Illinois had the highest rates of patient dumping because of economic difficulties. Researchers have reported that the language in COBRA was not precise enough to significantly disincentive healthcare providers to discontinue patient dumping practices. For example, in the 1980s Texas state law had a loophole that allowed hospitals to transfer patients to nursing homes.
In the 21st century, patient dumping continues to be a problem. University of California Los Angeles professor Emily Abel (2011) claimed that these policy interventions have not been effective because the United States' health care system is too heavily influenced by the patients' ability to pay. In the early 21st century, undocumented immigrants were reportedly subject to patient dumping by being deported or repatriated.
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Patient dumping
Patient dumping or homeless dumping is the practice of hospitals and emergency services releasing homeless or indigent patients to public hospitals or onto the streets instead of transferring them to a homeless shelter or retaining them. These cases usually require expensive medical care with minimal government reimbursement. The term "homeless dumping" has been used since the late 19th century and resurfaced throughout the 20th century alongside legislation and policy changes aimed at addressing the issue. Studies of the issue indicate mixed results from the United States' policy interventions and propose a variety of ideas to remedy the problem.
The term "patient dumping" was first mentioned in several New York Times articles published in the late 1870s that described the practice of private New York hospitals transporting poor and sickly patients by horse-drawn ambulance to Bellevue Hospital, the city's preeminent public facility. The jarring ride and lack of stabilized care typically resulted in death of the patient and outrage of the public. Scholars report that private hospital administrations were motivated by a desire to keep mortality rates and costs down when they advised ambulance drivers to send poor patients in critical condition directly to public hospitals like Bellevue even if a private hospital was closer.
After the deaths associated with patient dumping or patient transfer added up, the first attempt at legislative reform in the United States was pushed through the New York Senate around 1907, largely by Julius Harburger. That legislation penalized private hospitals when they sent ill patients away or obligated staff to transfer them to another hospital. Notwithstanding the passage of city ordinances prohibiting the practice, it continued.
The practice of patient dumping continued for several decades, and in the 1960s, it was brought back into the public eye by the media, but not much was done to resolve the issue. Many homeless people who have mental health problems can no longer find a place in a psychiatric hospital because of the trend towards mental health deinstitutionalization from the 1960s onwards. It continues to this day especially in New York City, where Bellevue receives a large share of Manhattan's indigent population.
"Patient dumping" resurfaced in the 1980s, nationwide, with private hospitals refusing to examine or treat the poor and uninsured in the emergency departments (ED) and transferring them to public hospitals for further care and treatment. In 1987, 33 complaints of patient dumping were made to the United States Department of Health and Human Services, and the following year 1988, 185 complaints were made. Since private hospitals ceased publishing their mortality rates, analysts pointed to high costs of dealing with Medicaid's reimbursements and uninsured patients as the motivation.
This refusal of care resulted in patient deaths and public outcry culminating with the passage of a federal anti-patient dumping law in 1986 known as the Emergency Medical Treatment and Active Labor Act (EMTALA). In 1985 the Consolidated Omnibus Budget Reconciliation Act (COBRA) was passed that was meant to regulate how patients were transferred and also end patient dumping. COBRA was not a complete solution, and in the years after its passage, hospitals struggled with creating appropriate discharge protocols and the cost of providing health care for homeless patients.
Statistically, Texas and Illinois had the highest rates of patient dumping because of economic difficulties. Researchers have reported that the language in COBRA was not precise enough to significantly disincentive healthcare providers to discontinue patient dumping practices. For example, in the 1980s Texas state law had a loophole that allowed hospitals to transfer patients to nursing homes.
In the 21st century, patient dumping continues to be a problem. University of California Los Angeles professor Emily Abel (2011) claimed that these policy interventions have not been effective because the United States' health care system is too heavily influenced by the patients' ability to pay. In the early 21st century, undocumented immigrants were reportedly subject to patient dumping by being deported or repatriated.