Patient dumping

Early history The term "patient dumping" was first mentioned in several New York Times articles published in the late 1870s that described the practice of private New York hospitals transporting poor and sickly patients by horse-drawn ambulance to Bellevue Hospital, the city's preeminent public facility. The jarring ride and lack of stabilized care typically resulted in death of the patient and outrage of the public. Many homeless people who have mental health problems can no longer find a place in a psychiatric hospital because of the trend towards mental health deinstitutionalization from the 1960s onwards. It continues to this day especially in New York City, where Bellevue receives a large share of Manhattan's indigent population. 1980s resurface in the public eye and policy interventions "Patient dumping" resurfaced in the 1980s, nationwide, with private hospitals refusing to examine or treat the poor and uninsured in the emergency departments (ED) and transferring them to public hospitals for further care and treatment. In 1987, 33 complaints of patient dumping were made to the United States Department of Health and Human Services, and the following year 1988, 185 complaints were made. COBRA was not a complete solution, and in the years after its passage, hospitals struggled with creating appropriate discharge protocols and the cost of providing health care for homeless patients. In September 2014, the United States Commission on Civil Rights issued a report entitled "Patient Dumping". == Statistics ==

A 2001 study by the Public Citizen's Health Research Group stated that there were widespread violations of EMTALA throughout the United States in 527 hospitals. Between 2005 and 2014 another study reported 43% of the US hospitals studied had been under EMTALA investigation that resulted in citations for 27% of the hospitals. The other findings of this study were that the number of EMTALA violations have been decreasing for the period between 2005 and 2014, and that the majority of the citations were given to hospitals for issues with policy enforcement. However, there is not a consensus among researchers about how to effectively measure the effects of EMTALA at reducing patient dumping or improving patient care. == Associated factors ==

Patients living in poverty or in homelessness are often seen as less than ideal patients for hospital administrations because they are unlikely to be able to pay for their healthcare and tend to be hospitalized with severe illness. Some researchers and scholars trace the issue of homeless dumping to the issue of homelessness and claim that addressing the issues of homelessness will prevent patient dumping. Social factors have allowed homelessness and poverty rates to further increase, and deinstitutionalization has led to psychiatric patients to lose access to services and be dumped on the streets. == Intervention strategies ==

While the introduction of Medicaid and Medicare helped hospitals shoulder the burden of providing care to poverty-level and elderly patients, many people in the United States without health insurance were still vulnerable to inappropriate patient transfer or dumping. Some scholars described how EMTALA provided a means to take legal action against healthcare providers and hospitals that did not comply, and provided examples of cases in Florida, California, and North Carolina. A study conducted on doctors at the Fairview Health Services hospital in Minnesota reported that grouping doctors into teams to incentivize collaboration provided high quality health care for the patient. A 2015 study conducted using information about homeless patients in New Haven, Connecticut, reported that homeless patients had a 22% higher hospital readmittance rate than patients with insurance. == Global perspective ==

Canada A study conducted on physicians in Ontario investigated how different payment systems impacted patient care in terms of the number of cost shifts and dumping incidents and reported that other factors like altruism or ethics of the doctors and patient behavior played a role in how doctors shifted costs. Some researchers hold the view that the Canadian healthcare system is better designed to minimize the occurrences of patient dumping. Researchers reported that funding issues with government budgets and pressure that hospitals felt to stay competitive were among the contributing factors to patient dumping. United Kingdom In a study conducted in the United Kingdom the issue of inappropriately discharging a patient has more to do with delaying the discharge than expediting the discharge. ==Usage==

Other associated names or terms Other terms used in relation to the practice of patient dumping are frequent-user patient, revolving-door, and bed blockers. Usage in the media and press • Associated Press; February 9, 2007; Los Angeles. A hospital van dropped off a homeless paraplegic man on Skid Row and left him crawling in the street with nothing more than a soiled gown and a broken colostomy bag. Police said the incident was a case of "homeless dumping" and were questioning officials from the hospital. • Associated Press, October 25, 2006; Los Angeles. "L.A. Police Allege Homeless Dumping." Authorities have launched a criminal investigation into suspected homeless dumping on Skid Row after police witnessed ambulances leaving five people on a street there during the weekend. == See also ==