Patient dumping
[4] Studies of the issue have indicated mixed results from the United States' policy interventions and have proposed a variety of ideas to remedy the problem.
[5] 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.
[4] 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).
[14] 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.
[5] Researchers have reported that the language in COBRA was not precise enough to significantly disincentivize healthcare providers to discontinue patient dumping practices.
[4] 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.
[20] Social factors have allowed homelessness and poverty rates to further increase, and deinstitutionalization has led to psychiatric patients to lose access to services and be dumped on the streets.
[5] Scholars and researchers point to these patients' lack of access to preventative and consistent healthcare treatment, as well as inappropriate discharge procedures and follow-up protocols, as the causes behind the frequent rehospitalization.
[21] In 2009, legal scholars Jeffrey Kahntroff and Rochelle Watson reported that the implementation of the policy has been flawed with issues of lack of adherence and confusion on what is compliance.
[7] In 1988, COBRA was meant to be a series of revised regulations which required hospital emergency rooms to treat every patient that walked through the door and doubled the fine for violations.
Some researchers and scholars have concluded that despite the policy interventions of the 1980s, the practice of patient dumping continued to be a problem in the United States and that a solution required a reformation of the entire healthcare system.
[4][5] These researchers shared the opinion that the most effective solution to address the health care needs of people living in poverty and those who are homeless is to provide universal healthcare because that would eliminate hospitals' incentives to turn patients away based on their ability to pay for services.
[1][20] Another strategy to minimize rehospitalization rates proposed by researchers is to create recuperation programs for patients who lack access to one after they are discharged.
[23][24] A study conducted on physicians in Ontario investigated how different payment systems impacted patient care in terms of the number of cost shifts and dumping incidences[spelling?]
[26] Researchers reported that funding issues with government budgets and pressure that hospitals felt to stay competitive were among the contributing factors to patient dumping.
