MSN student - please help with research topic

  1. I am currently a MSN student working on a "arguementive" topic. I am interested in finding out if nurses feel that indigent patients or those with limited insurance (medicaid, medicare) are entitled to the same medical care and diagnostic testing as those with substancial insurances. Also, have you noticed that physicians tend to order different treatment and dx testing based upon insurances? This is a topic I feel very strongly about; I believe all patients should be treated equally regardless of insurance. What is your opinion and observations? Thanks so much.

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  2. 17 Comments

  3. by   njohnson
    I have a family member that is an indigent patient. She is disabled, on medicare, and not able to get prescription drug coverage. Her doctor's office would frequently not send in her indigent forms and she would have to go for periods without her medicine. The medical clerk that handled the forms would constantly complain to my indigent family member that she didn't have time to deal with the forms and that they weren't her job. She would also warn my family member that she may not get to them at all. This made my family member very upset. She didn't have anyone to turn to. So, she thought that maybe by telling the doctor what was going on might help. Her doctor got right in her face and told her that indigent patients didn't generate any revenue for his office and that they have been contemplating not servicing indigent patients anymore. He also told her that those indigent forms were not thier job and maybe if she lost weight she could get a job and afford decent medical insurance that covered her medications. Needless to say, I advised her to drop that sorry doctor right away!! She changed physicians and is now happy at a clinic that will process her indigent forms with no problems.
  4. by   TravelingTexan
    "There, but for the grace of God, go I." I agree that some doctors (as well as many others from all walks of life) may need reminding every once in a while of that little truism. Everyone is entitled to the best care available.
    It is very sad that so many people get caught up in "making a living", or watching the bottom line, instead of doing something for someone... doing something that matters... making a difference. Which is an easy trap to fall into, but is still no excuse.
    I fully realize that doctors must indeed make a living at what they do... but there is more to thier "job" than making a living.
  5. by   NorthernRN
    "I am interested in finding out if nurses feel that indigent patients or those with limited insurance (medicaid, medicare) are entitled to the same medical care and diagnostic testing as those with substancial insurances." As a nurse, without question, ALL people are entitled to the same quality medical care afforded those with full insurance plans.

    "have you noticed that physicians tend to order different treatment and dx testing based upon insurances?" In my practice, I am fortunate to be able to say that I have not seen a physician or practitioner treat, examine, or order diagnostics based upon the patient's insurance availability.

    Good luck with your study! Would love to see the results....

  6. by   iamme457
    OK, where should I start with this one. Patient advocate.....my patient should receive the same treatment as anyone in this facility. A true indigent rarely cries for better care than what her room mate is receiving nor does the financially stable patient. The patient and patients family when under a lot of stress may be more demanding for a few days until they realize the nurse and doctor are doing what is best for that patient. I have not seen any different testing, care or treatment for simular medical problems be dependant on different income or insurance basis. Sometimes your health care insurance can be the culprit on what test is done first for a specific problem but that is more on a outpatient basis. When in the hospital in an intensive care unit I dont see any differences in patient care or treatment.
    I have always worked in teaching/non-profit facilities so I dont know what the for profit facilities function like.
    But please dont try to offer this information to a paranoid schizophrenic after the sun goes down, I had an on and off 2 1/2 hour discussion last evening about how that facility had given her the same food tray with the same uneaten food on it for dinner for 3 days in a row. Couldnt explain anything to her as she was sure of this.
    Point is that everyone will have a different perspective of the same situation especially when under stress. We are all under some stress, nurse is responsible for patients best interests, the patient is scared, the doctor is also responsible for this patient and must choose if the nurse or patient is correct in what is happening here.
    Oh by the way, I did get some different and just as fresh food for this patient.
    Good luck with your arguementative survey
    Deanna
  7. by   Doey
    I work in critical care in a 200 bed not-for-profit community hospital with a diverse population ethnically and financially. I have seen no difference in the way the pts. are treated medically, including diagnostic testing, labs, surgery, or referrals to specialists, that is based on what type of insurance, if any, a pt. has. Although at times I have seen some procedures/tests delayed due to a pt's particular private insurance. And yes I too feel everyone should be treated equally regardless of insurance. Good luck with your research!

    [This message has been edited by Doey (edited August 30, 2000).]
  8. by   maikranz
    Greetings!
    I suppose my problem is semantics: "entitled"
    I think that everyone has a right to "equal access" to healthcare, regardless of ability to pay. But entitled.....
    As per other post-ers, the delays are insurance alot of times: the pre-cert wasn't done, or the PCP wasn't consulted and the client self-referred, stuff like this. Makes one wonder why more people don't complain and carry-on to their insurers, to whom they are paying such high premiums.
    (Now in France: I was listening to NPR, and an on-going commentary from a US citizen living there outlined his experiences with their healthcare system. It will surprise you.)
    Re: your argumentative discourse. Are you proposing the Pro or the Con aspect? Be careful that you don't let your emotions interfer with the point you are trying to make: no one will take you seriously.
    Good luck with your endeavors. You will grow to love group work
  9. by   KSEFLINK
    I have seen a difference in treatment options for a patient related to insurance. I have seen it related to age and other medical conditions.I have experienced it most from a managed care perspective. Some differences may be in not being able to get the correct medicine ordered because it is not on formulary or getting a diagnostic test okayed because the patient is "not ill enough yet" Most hospitals today have to build "indigent" charity care into their annual expense, so in the acute facilities, care is mostly the same. Physicians are hardly getting paid for their time in healthcare facilities as it is with reimbursement ratios being what they are, so the time they spend on any patient is nonpayable in part. With new medicare and insurance rulings, as well as the federal balanced budget act, all care (even to those of us who are insured) is being manipulated to a point. Just ask your UR nurses or case managers. People who are sick should be able to get the care they need, no matter whether or not they can pay for it. In all cases, it is not happening. Just ask a medicare patient waiting for a transplant or someone in need of an experimental or research based treatment.
  10. by   DebraJo
    Well here's an interesting thought. Although in theory I agree that everyone should be entitled to the same level of care, who is going to pay the bill for it all? How many nurses do you really know that would do without a pay raise to make sure all received access to the same care? Not many I'll bet. I just recently left management and believe me, those nurses wanted money; the heck with patient needs.
    It is a fact, like it or not, that the medicare and medicaide are paying less and less for services. Yet, health care organizations need to pay the going rate for utilities, staff, insurance etc. When was the last time any of you said to your electric company "well I know your charges are $100 but we'll give you $25...take it or leave it" .
    I'm all for helping some patients but what about the ones who have money or cigarettes or illegal substances but no money for medical care?
    I know I sound hard hearted but as nurses we are demanding top salaries (owing in part to the shortage) which is just adding to the problem by making health care more expensive. Until we as a nation decide who is going to pay the bill, I don't see how things can be equal.
    Debra Moyer



    [This message has been edited by DebraJo (edited September 10, 2000).]
  11. by   feminist nurse
    If you believe that every one in this country is entitled to the same care, then you must believe in universal healthcare.

    The california nurses believe as you do and they've endorsed Ralph Nadar for president to draw attention to the issue.

    Nadar is the only candidate with this belief. However, most nurses feel as you do but fail to vote their beliefs.

    One in 44 registered voters is a nurse.
    We can make a difference if we vote in a block!
  12. by   purplemania
    The physicians I have worked with in the past had no idea what kind of ins. a patient had UNLESS it interfered with his care plan. Usually that meant the ins. would not pay for a rx/procedure and the patient would not or could not either. Now I am a staff nurse and I still don't know who has what kind of ins. The social worker takes care of pt needs not covered by ins.Part of the problem is that people want steak coverage at hamburger prices. Perhaps we SHOULD consider a national health plan. My son lives in Sweden. His taxes are close to 50% of his salary. But with my tax base, plus realestate tax, sales tax, etc. mine is about the same and I pay extra for insurance (partially paid for by employer)
  13. by   BabyCNS
    Historically, all nurses use to be contract nurses. They would hire their skills out to families and be paid by them. This was before insurance companies played a part and the fact that hospitals began looking at the profession as part of the bed cost. If you do your reading you will find that nursing schools as part of hospitals flourished in response to war time, and that students became part of the hospital system during the Great Depression in order to survive. When I look around, almost most people with ill health are those that are covered by medicaid or medicare. Even those having children are frequently on those programs. I had my last child on state welfare and had the best healthcare without a bill. When I had insurance I paid aproximately 1000.00 in addition to the insurance costs. In all of my years as a nurse, I don't see nurses choose their care based on the ability of payment. Its not like you are earning a tip dor the care tht you deliver.

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  14. by   el
    Shame on you Debrajo! To buy into the fact that paying for nurses to give care in hospitals is really what is causing the healthcare cut backs is unbelieveable. If you just left management you must know what they are getting paid. I can assure you, that the masses of people on hospital pay rolls that have desks and sit in them most of the day writing policies and balancing budgets are much more the problem then the bedside nurses. A couple less chiefs in each hospital nation wide would probably be a start, not nurses. We are a profession, we deserve to be paid for our education and knowledge and hard work. Yes, insurance companies are the biggest part of the problem, they are getting richer and richer taking peoples money and then refusing to pay for their care deemed necessary by their doctors. Yes, hospitals have for years been cutting patient care personnel for profit. Yes, Nurses have worked themselves ragged for years trying and trying, and crying, and begging for more help. I am sorry but it is infuriating to me to look to the nurses to fix the problem with our healthcare delivery system, we are the ones that always knew it was moving away from quality care and all the "desks", were not concerned before now. Anyway, as far as the topic goes, I haven't experienced people receiving lower quality care in charity care, I do think the people with insurance often don't have tests done because their insurance refuses it.

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