Discharge often difficult at children's hospitals
Discharge often difficult at children's hospitals
Too few post-acute pediatric options exist
A researcher and pediatric physician who has studied insurance and immigration issues related to medical care has found that several myths create an emotional response that complicates the medical and political issue of who should pay for health care for undocumented immigrants.
For example, the average costs of medical care for immigrant children is considerably less than the cost of medical care for children who are not immigrants, says Susmita Pati, MD, MPH, senior co-director of the Children's Hospital of Philadelphia (CHOP) and director of research programs for FOCUS, which is a program supported by the Dean of the University of Pennsylvania's School of Medicine.
Pati also is an assistant professor of pediatrics at CHOP and the University of Pennsylvania in Philadelphia.
Pati's research has shown that what is spent on health care for an immigrant child is one-third as much as the average spent on children who are not immigrants.1
And immigrant children are far less likely to be insured, particularly through public health insurance, since immigration reform in the late 1990s.2
"The prevailing misconception in the general populace is that immigrants are draining our health care system because they don't have insurance and that it costs more to take care of them," Pati says.
"Another myth is that tons of immigrants are on public insurance rolls, and the study I published shows that also is not true," Pati says. "Immigrant kids are much more likely to be without coverage."
However, discharge planning for hospitalized children is challenging regardless of the child's insurance or immigration status, she notes.
"We might have trouble finding an appropriate home care provider when children need antibiotics via IV or if they need additional therapy for a head injury in an accident," Pati explains.
There are too few long-term care or rehabilitation facilities for children, she says.
"It's a chronic problem, and for children who have mental health needs, inpatient psychiatric facilities are incredibly lacking, as is reimbursement for those types of services," Pati says.
"Some things are easier to arrange than others," she adds. "But in general, long-term types of care like rehabilitation are very poorly reimbursed when compared with antibiotic administration, and those are inherent challenges we have in the system."
At CHOP, there is a dedicated group of people who work to find coverage for children who don't have it, Pati says.
"When a family doesn't have insurance coverage, they work with the family to apply for whatever they might be eligible for or to arrange for a payment plan or for charity care," she says. "Those are the three options."
Many hospitals do not provide this service, Pati notes.
"Unfortunately, there are cases where no post-hospital care can be worked out very quickly, and children sometimes stay in the hospital a few extra days," she adds. "But that's obviously not ideal for anybody."
This is one of the situations where hospitals and discharge planners cannot fix the problem through their own individual efforts.
"Almost no solution can be handled singly by providers," Pati says. "We need public policy changes."
Children can languish in the hospital while medical providers cope with finding an appropriate skilled facility, ensuring post-acute medical care will be covered, and communicating with families who often do not speak English as their primary language, Pati explains.
"There are plenty of cultural and ethnic community-based organizations you can tap into as resources," she notes. "But if you talk about a child who needs long-term rehabilitation, they're not able to do that; they can provide someone with a ride to a grocery store, but they can't give a child physical therapy."
American society would benefit as a whole if leaders would address and resolve this problem, Pati says.
"I don't know what will happen in this current political environment," she says. "The American public understands the problem with health care coverage, but the debate gets hijacked, and people lose sight of the larger picture."
Ideally, there should be no child living in this country without high-quality, affordable, and comprehensive health care coverage, Pati says.
"Children are where an ounce of prevention is worth a pound of cure, and if we don't invest in children from birth to three years of age, we end up paying for it many times over," she adds.
1. Mohanty SA, Woolhandler S, Himmelstein DU, et al. Health care expenditures of immigrants in the United States: a nationally representative analysis. Am J Pub Health. 2005;95(8):1431-1438.
2. Pati S, Danagoulian S. Immigrant children's reliance on public health insurance in the wake of immigration reform. Am J Pub Health. 2008;98(11):2004-2010.
For more information, contact:
James Dwyer, PhD, Associate Professor, Center for Bioethics and Humanities, SUNY Upstate Medical University, 618 Irving Ave., Syracuse, NY 13210. Telephone: (315) 464-8455. Email: [email protected].
Eve Green Koopersmith, Esq., Partner, Chair, Discharge Planning, Patient Rights and Elder Law Practice Group, Garfunkel, Wild & Travis, 111 Great Neck Road, Suite 503, Great Neck, NY 11021. Telephone: (516) 393-2200.
Susmita Pati, MD, MPH, Senior Co-Director, PolicyLab; Director of Research Programs, FOCUS; The Children's Hospital of Pennsylvania; Assistant Professor of Pediatrics, University of Pennsylvania, 34th & Civic Center Blvd., Philadelphia, PA 19104. Telephone: (267) 426-5056. Email: [email protected]
Linda S. Quick, President, South Florida Hospital & Healthcare Association, 6363 Taft St., Suite 200, Hollywood, FL 33021. Telephone: (954) 964-1660. Email: [email protected].A researcher and pediatric physician who has studied insurance and immigration issues related to medical care has found that several myths create an emotional response that complicates the medical and political issue of who should pay for health care for undocumented immigrants.
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