The fact that some patients are either underinsured or totally uninsured to an extent they cannot afford some medical services is becoming rampant. Those who seek medical attention from certain health facilities without proper insurance cover face a lot of challenges. Some indigent patients are encountered with the unsound option of skipping necessary medical care because of financial challenges. During an economic recession, hospitals are faced with a financial crisis to an extent the management team finds it difficult to decide on medical services to offer (Jesus et al., 2019). For instance, admitting a patient for dialysis treatment is quite expensive and unaffordable for some patients. Therefore, sound decisions should be made by the management using relevant models on how to handle indigent patients.
Problem Definition
The hospital has mistakenly admitted an indigent patient as an inpatient for dialysis treatment. The county’s property taxes fund the hospital, and therefore, it cannot provide such medical services. It is beyond the hospital’s ability to offer required health services to the patient since it is considered an inappropriate way of using local property taxes according to the hospital rules and regulations. On the contrary, if the indigent patient is cleared from the county hospital and treatment of dialysis terminated, the victim will experience adverse medical conditions and even death. The hospital has a choice of keeping the patient for dialysis treatment on the condition of catering for all medical costs on behalf of the patient. Performing dialysis is expensive and against the rules of the hospital, but at the same time, the life of an indigent patient is at stake if discharged.
Stakeholders Identification
- Management team of the hospital
- County administrators/ officials
- Donors and well-wishers
- Financing companies
Alternative Solutions Identification
- Money conversation with the patient
- Referring or helping the patient find assistance
- Barter
- Suggest a payment plan
- Bringing on board financing companies
- Offering care pro bono
- Creating a sliding fee scale
Alternative Solutions Evaluation
Money conversation with the patient
Having a reasonable conversation with the patient can result in cost-saving without necessarily reducing medical care quality or terminating it. However, the management team and other county officials are not trained on discussing financial matters with patients.
Referring or helping the patient find assistance
The county hospital can refer the patient to other health care facilities with affordable services. The hospital can also help the patient find support from relevant well-wishers and other donor programs using appropriate channels.
Barter transaction
Some patients who are facing financial challenges pay for their medical bills in goods or services. Quite often, barter transactions are favorable when the medical bills are not high, and medical services are less complicated. Some patients can volunteer to work in a hospital to offset their medical bills after treatment. However, it may not be applicable when the patient is poor and does not have a reasonable asset to offset the huge balances such as dialysis treatment bills.
Bringing on board financing companies
Another alternative solution to help patients offset their medical bills is by bringing on board financing organizations. However, it is challenging for the poverty-stricken patient to afford the financing companies’ services because the money has to be paid together with interest rates.
Creating a sliding fee scale
Another way of offering financial help to patients with financial constraints (both self-pay patients and low-income patients) is by creating a sliding fee structure. The fee schedule offers a discount on families’ income following the guidelines of Federal Poverty Guidelines (Schmedthorst, 2017). Conversely, the poor patient has no income and discount relief to apply for financial help.
Suggest a payment plan
Another reasonable alternative is to accept whatever amount the patient can pay at the current time and sign an agreement on how the remaining amount will be cleared. Nevertheless, the alternative will not work since a poor patient has no source of stable income to pay for medical bills in the future.
Offering care pro bono
Some patients have extreme financial challenges and health problems to match. The hospital can decide to offer care pro bono to indigent patients without any payment. The challenge with care pro bono occurs when the hospital is facing a financial crisis and cannot provide medical services for free.
Selected Alternative
The best alternative after the thorough evaluation is to refer or help the patient find relevant organizations’ assistance. A patient might have limited knowledge of where to get help and access donations. With the hospital’s help, it is easier to identify an organization willing to help an indigent patient. For instance, several nonprofit organizations globally are formed to help poor and low-income groups without expecting repayment (Chikoto-Schultz and Neely, 2016). Stakeholders can identify the appropriate nonprofit organizations and apply for help on behalf of the indigent patient by following rules and proper ethical channels.
Conclusion
Sometimes it is hard to make a medical decision involving the hospital’s financial position and a needy patient’s health condition. It is appropriate to help low-income patients to acquire quality medical services. Balancing the budget of a hospital while trying to help the poor patients is, most of the time, challenging. However, several alternatives of addressing the issue in the health institutions exist. A hospital can select the most effective way to save a life by either referring the patient to another facility with affordable services or helping the patient get help from nonprofit organizations.
References
Chikoto-Schultz, G., and Neely, D. (2016). Exploring the nexus of nonprofit financial stability and financial growth. International Journal of Voluntary and Nonprofit Organizations, 27(6), 2561-2575. Web.
Jesus, T., Kondilis, E., Filippon, J., and Russo, G. (2019). Impact of economic recessions on healthcare workers and their crises’ responses: Study protocol for a systematic review of the qualitative and quantitative evidence for the development of an evidence-based conceptual framework. BMJ Open, 9(11), 1-8. Web.
Schmedthorst, A. (2017). 10 ways to help patients when they can’t afford care. Kareo. Web.