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.