The cost of care
By JOSHUA MELVIN
jmelvin@hcnonline.com
04/21/2008
There are 47 million Americans who don't have health insurance. One way they seek medical care is through emergency rooms.
In hospitals across the nation illegal immigration is a reality not a debate.
A world away from the arguments of lawmakers and the opining of experts, medical professionals are doing what they can to keep up the significant burden placed on the health care system by undocumented immigrants who arent insured.
The hospitals of northeast Harris County are no exception.
While local facilities are not at the epicenter of the situation, they sit just outside of a city that, according to Eduardo Sanchez, director of the Institute for Health Policy in the University of Texas School of Public Health at Houston, has an undocumented population of 100,000 to 150,000.
Area hospitals are also in the upper corner of a county that director of Research at the Center for Immigration Studies Steven Camarota said is home to more than 380,000 illegal immigrants.
But the number of illegal immigrants served is difficult to gauge. As hospitals do not inquire into immigration status there is really no way to say who is who.
You dont check a box that says, Im an illegal immigrant, said Kingwood Medical Center marketing director Marilyn Gerry.
But Kingwood Medical Center and Memorial Hermann Northeast both said illegal immigration is affecting them.
At KMC volume is, according to Gerry, one of the major impacts. Because the hospital is having to treat more people, the process gets slowed down.
[Illegal immigrants] back up the system, she said.
According to Memorial Hermann Northeast CEO Louis Smith, capacity is not a problem. Rather, he pointed to some different issues his hospital is facing.
When you are talking about undocumented workers you are talking about folks not traditionally seeking care on a regular basis, he said.
Thus, by the time illegal immigrants reach the hospital, a possibly preventable issue has become an acute one which is difficult and expensive to treat.
Language is also a problem.
We have to get [interpreters] who are certified in medical language, Smith said. Just speaking a language is not enough, as improper translation can result in dangerous miscommunication.
These issues that hospitals are facing are not likely a big surprise.
Since a higher percentage of the undocumented dont have insurance, said Sanchez, they are likely to seek care in those places that serve individuals who dont have insurance.
The emergency rooms are on the short list of where illegals without insurance can seek care.
One of the ways illegal immigrants access health care starts with an act of Congress.
As a result of the Emergency Medical Treatment and Active Labor Act, which was passed in 1986, hospitals are required to give emergency medical services to anyone regardless of immigration status or ability to pay.
The act was passed to counteract a practice called patient dumping where those who werent able to pay for medical care were discharged or transferred.
[Emergency room patients] are given a medical screening exam, said Gerry.
If the patient is in need of urgent care, they receive it; if not, they are referred or discharged said Memorial Hermann Northeast emergency nurse practitioner Troy Peet.
The start and end result of this situation can be understood quickly by looking at costs.
According to Sanchez, money is what keeps the undocumented patient from getting insurance.
The cost of health insurance right now in this country is on the order of $12,000 for a family of four, he said. Undocumented immigrants are going to be in general lower income earners.
In return the hospitals are absorbing the cost of providing care to illegal immigrants, although numbers are hard to pin down.
We see illegal immigrants, we do not, however, track them, said Gerry.
However, the cost of providing health care for those without insurance, which includes uninsured illegal immigrants, is tracked.
In the Memorial Hermann system in the Houston area there was collectively $147 million in unpaid or charity medical care in 2006.
Memorial Hermann shoulders more than any health care system in Houston, even compared to the Harris County Health District, Smith said.
Gerry echoed the enormity of the cost.
At Kingwood Medical Center alone, its millions of dollars per year in charitable care, she said.
While some of the uncompensated bills are written off as bad debt or taken care of by state and federal programs, almost all of it is paid for by the hospital.
One way this cost is offset is something Sanchez called cost shifting.
The premium for a family of four may be as much and $1,500 higher because of the care thats provided to the uninsured, he said. It is the burden of the uninsured.
