MSN student - please help with research topic

el · Sep 18, 2000

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.

JillR · Sep 18, 2000

I have not seen a difference in what the doctors order regarding indigent patients vs insured patients, What I have seen however is the insured patient who cant get the test because the insurance company will not aprove it.

I have also noticed that it's not the indigent or the insured that don't get procedures or tests done as much as I see those who "fall throught the cracks". It is the working class people that do not have insurance and cannot afford to buy thier own that commonly have to chose between paying the bill or paying for that medication and paying the rent.

These are the problems I see in my area.

Do I belive that the indigent desreve the same quality of health care? Yes, I believe that all people deserve the same quality of health care. I just don't see it happening due to ability to pay.

Jill

ClariceS · Sep 19, 2000

I work in a not-for-profit teaching (county) hospital and have not seen differences in what is ordered for patients with or without insurance. I have seen the problems of a procedure being delayed due to insurance not wanting to pay. I have also seen some patients who have said they were told they couldn't go to the other hospital (for-profit) in town because they didn't have insurance. What I have seen greatly increase over the past few years is the demands from indigent patients because they believe they are being treated differently. Demands for anything from private rooms (for comfort not medical need), extra food trays for family (we don't supply this for any patient regardless) to earlier treatments or more frequent x-rays or ultrasounds. I have had more than one indigent patient tell me that the only reason I won't help arrange this for them is that they have no money. They don't believe that we don't do this for anyone regardless of their insurance status.

cheryllynn59 · Sep 19, 2000

I fully agree that all patients should be treated equally. Where I live the doctor/patient ratio is somewhere in the neighborhood of 1:5000. Medicare patients are even having difficulty getting care because of the high paperwork/low reimbursement issue. Indigent patients get no care at all.

tracyfnp · Sep 22, 2000

NJOHNSON, I AM ALSO AN MSN STUDENT AS WELL AS AN FNP STUDENT AND I AM INTERESTED IN KNOWING IF YOU THINK THE US SHOULD MOVE TO A SOCIALIST FORM OF HEALTH CARE? I HAVE BEEN READING ABOUT THE UK AND FIND THAT THEIR SYSTEM MAKES ALOT OF SENSE. WHAT DO YOU THINK?

Originally posted 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.

darla80 · Sep 25, 2000

Originally posted by TBoltRN:
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.

I have read with much interest the responses to your question about indigent patients. I work for an Internal Medicine physician and we take care of many indigent pts.

I will tell you that a patients indigent status does not affect this physicians orders for tests to make a diagnosis or the care given to the pts. He does order the least expensive test that will enable him to make the DX. If an ultrasound will do it he does not order a CT or if CT will be enough he does not order an MRI. etc .. It is worthwhile to point out that we as a practice do not get any money for the test anyway. Patients seem to think the doctor gets paid for the lab/ x ray , CTs etc.

I will agree with others that the insurance companies are often the regulating factor for the patients. We have had patients who did not want the test if the insurance would not pay.. even if the Doctor felt the test could change the outcome of care.

In response to those who commented on "Indigent forms"

Do you have any idea about the time commitment it takes to institute these programs? Filling out the forms is one piece to the puzzle.. the meds must be ordered, tracked, reordered, received in the office, logged in, and then dispensed to the pt.

If any of you have relatives receiving indigent meds please be patient with the office and even ask if there is any part of the paperwork quagmire that you can help with

Also many of these pharmaceutical companies require the patient to fill out paperwork and they are often unwilling to do so. Did you know each drug requires different forms? Standardized forms would be nice. The paperwork really is a deterrent.

What has happened to gratitude among the indigent patients? Many times they feel you owe them even more than they are getting. I have had more than one patient come to the office with a pocket filled with cigarettes screaming that he does not have enough money for meds.

My question is:

Do you experience ingratitude from the indigent population you try to help?

I Love nursing and love my patients.. it is the paperwork that slows me down