Doctor Seeks Mandatory Hospital Treatment of Accident Victims
(APW_ENG_19960122.0419)
1) A system to compel Thai hospitals to accept accident victims may be needed since patients, especially poor ones, are almost routinely turned away, a government doctor said Monday.
2) State and university hospitals, as well as private institutions, are guilty of sending away emergency cases, Dr. Somchai Kanchanasut, chief of the accident and emergency department of Bangkok's state-run Ratchavithi hospital told The Associated Press.
3) In some cases, the accident victims have died en route to a second or third hospital after being refused entry at the first emergency room to which they were brought, he said.
4) ``This bad tradition has been going on for decades. Doctors have seen so much of this that they no longer remember their medical morality,'' Somchai said in a telephone interview.
5) To help solve the problem, Somchai is seeking support for his idea of setting up zones in which hospitals would have to take responsibility for accident victims in their respective areas.
6) He is also seeking to have 15 major hospitals in Bangkok set up Emergency Medical Service (EMS) units to treat accident victims on the spot.
7) Private hospitals are most notorious for turning away patients when it is suspected an accident victim would not have enough money to pay for his treatment.
8) Somchai said some hospitals pay 300-to-500 baht (dlrs 12-20) for private rescue workers _ who are often first on the scene at accidents _ to bring in well-to-do patients.
9) At the same time, hospitals are willing to pay slightly more to have the rescue workers haul impoverished patients off to another hospital.
10) State-run hospitals, overcrowded and short-staffed, also sometimes try to pass the buck, Somchai said. Rather than increase their workload, they will often tell victims seeking admittance that all their beds are full, he said.
11) Somchai said that hospitals attached to universities sometimes reject accident victims because they are more interested in having patients with uncommon ailments that represent more interesting cases for their student interns.
12) ``Anyone with appendicitis is in trouble if he is taken to such a hospital because it is a common disease,'' said Somchai. ``The hospitals have already had a lot of these cases to study.''
Hospitals Ordered to Put Patients' Care First
(APW_ENG_19961127.0069)
1) Horror stories and complaints about bad care from hospitals that seem more concerned about making money than providing good medical care have led the government to issue new rules.
2) Rule No. 1: The work of a hospital is always for the sake of its patients, to provide good quality medical service, to deal with patients in an enlightened, hospitable, ethical way, the Communist Party organ People's Daily reported Wednesday.
3) The Health Department will first require compliance with its ``ten commandments'' at 10 hospitals designated as ``Enlightened Service Model Hospitals,'' said the report, carried in several national newspapers.
4) The rules will gradually be phased in at other medical facilities.
5) After decades of free medical care at government expense, cash-strapped hospitals and clinics have begun requiring patients to foot more of the bill for their care. Many Chinese complain they cannot afford the fees, as well as the bribes often expected for good care.
6) Among other things, the rules say hospitals should end what Chinese have dubbed the ``three longs, one short'' _ long waits for medicine, registration and care and the usually brief visit with a doctor.
7) Emergency wards should begin procedures for each patient within five minutes after arrival.
8) Arbitrary fees and sales of medicines whose expiration date has already passed should also stop, the rules say.
9) Hospitals should aim at a satisfaction rate of more than 95 percent among their patients, the report said.
10) The Health Department will carry out inspections to ensure compliance with the rules, the report said, without elaborating on any penalties for violations.
11) It provided a phone number for complaints.
Emerging Markets Datafile
(APW_ENG_19971218.1114)
1) December 18, 1997
2) BUSINESS TIMES
3) MALAYSIA
4) ENGLISH
5) Trim charges, Dr M urges private hospitals
6) Kamarul Yunus
7) ASIA
8) WorldSources Online, Inc.
9) 201 PENNSYLVANIA AVENUE, S.E., 2nd Floor
10) WASHINGTON, D.C. 20003
11) Tel: 202-547-4512
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13) COPYRIGHT 1997 BY WORLDSOURCES ONLINE, INC., A JOINT VENTURE OF FDCH, INC.
14) AND WORLD TIMES, INC. NO PORTION OF THE MATERIALS CONTAINED HEREIN MAY BE
15) USED IN ANY MEDIA WITHOUT ATTRIBUTION TO WORLDSOURCES ONLINE, INC.
16) PRIME Minister Datuk Seri Dr Mahathir Mohamad, while calling for a pay cut among specialists in private hospitals, hopes they will also offer lower charges to local patients in view of the current economic problem.
17) ``They should offer a discount to local patients whose income have dipped by 45 per cent (due to the currency problem),'' he said at the opening of Gleneagles Intan Medical Centre (GIMC) in Kuala Lumpur yesterday.
18) On the converse, Dr Mahathir said private hospitals can afford to charge a higher rate to foreigners because these patients are able to pay such a rate simply because the ringgit is now cheaper.
19) He reminded private medical and health practitioners that hospitals are dependent on the health status of the people.
20) ``If the people in the country are all healthy, there will be no need for hospitals. So you (private hospitals) depend on the natural misfortune of others.
21) ``But I am sure private hospitals are dealing with services which are much needed, and as such, they should have a vision for caring for those who are not able to afford the treatment at their hospitals.
22) ``I don't know how you are going to work that out but I am sure you do have a scheme to help the less fortunate.
23) ``Otherwise, they have to go to government hospitals,'' he said, adding that public hospitals are now facing increased pressure as a result of the ringgit depreciation which leads to more people turning to them for treatment rather than going to the private ones.
24) Thus, he said, private hospitals should try to encourage patients to go to their hospitals by offering not only attractive services and facilities but also charges. ``If you don't get patients, I am sure you will also suffer,'' he added.
25) To keep down the cost of treatment at private hospitals, Dr Mahathir also suggested a pay cut among their specialists.
26) ``I would like to suggest, if I may with due apology, that we all take a salary cut. We have to bring down the cost so that the charges for your patients, especially the poorer ones, will be less.
27) ``I am sure that the salary cut will not cause us to starve to death,'' he said, adding that Deputy Prime Minister and Finance Minister Datuk Seri Anwar Ibrahim had even imposed a 10 per cent salary cut on his (Dr Mahathir's) salary.
28) Acknowledging that many company executives have taken a pay cut in their salaries in response to the call by the Government, Dr Mahathir said such a move is part of their contribution to the well-being of the people and the speedy recovery of the country's economy.
29) ``I am glad to be told that since my nasty comments that executives should take a pay cut, many of them have already done so.
30) ``How much I don't know, but I am sure that Gleneagles Intan too will also like to contribute to the well-being of the country and the speedy economic recovery of the country,'' he added.
Emerging Markets Datafile
(APW_ENG_19980112.0608)
1) January 12, 1998
2) NATION
3) THAILAND
4) ENGLISH
5) Pricing scheme set to relieve burden on state hospitals
6) KWANCHAI RUNGFAPAISARN
7) ASIA
8) WorldSources Online, Inc.
9) 201 PENNSYLVANIA AVENUE, S.E., 2nd Floor
10) WASHINGTON, D.C. 20003
11) Tel: 202-547-4512
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13) COPYRIGHT 1998 BY WORLDSOURCES ONLINE, INC., A JOINT VENTURE OF FDCH, INC.
14) AND WORLD TIMES, INC. NO PORTION OF THE MATERIALS CONTAINED HEREIN MAY BE
15) USED IN ANY MEDIA WITHOUT ATTRIBUTION TO WORLDSOURCES ONLINE, INC.
16) PRIVATE hospitals, which have seen the number of patients fall by more than 20 per cent since the bursting of the bubble economy, are being encouraged to join a uniform pricing scheme organised by the Ministry of Public Health, as state hospitals have seen an influx of patients unwilling to go to private hospitals because of the economic difficulty.
17) The ministry will launch the programme in conjunction with private hospitals to help reduce the burden on state hospitals which have seen patients rise by 30 per cent since the middle of last year, according to Permanent Secretary Dr Prakrom Wutthipongse.
18) The programme will have private hospitals posting standard prices for medicines and doctor's fees for common ailments.
19) Uniform pricing will allow people to know in advance the cost of treatment and hospitalisation so they may consider using more private hospital services instead of going to overcrowded state hospitals, which are running beyond capacity.
20) Due to economic difficulty, fewer people go to private hospitals where revenues have fallen.Uniform pricing will be voluntary, according to Dr Prakrom.
21) By charging uniform prices, more people, especially middle-income earners, will feel private services are affordable.
22) The government will announce details of the programme by the middle of this year, he said.
23) There are about 38,000 private hospital beds nationwide, half of which are in Bangkok.
24) Uniform pricing will be a solution after many private hospitals, suffering from the economic downturn and a sharp plunge in the number of patients, have tried to consolidate their health-care businesses and considered merging with partners.They are moving to overcome the economic difficulty as well as to improve liquidity and efficiency. Many private hospitals have reduced their inventories to create better cash flow.
25) ''With the uniform price, we can encourage people to come back to use the treatment services in private hospitals,'' said Prakrom.
26) ''Without the uniform pricing, patients will become hesitant about using services in private hospitals as they do not know in advance the treatment charge,'' said Prakrom, adding that many patients going to private hospitals have been upset because of prices higher than they expected.The uniform pricing programme in private hospitals will also help to reduce the number of patients who shift their treatments to government hospitals.
27) The economic recession caused more than 30 per cent of private hospital patients to be shifted to public hospitals. This caused work overloads and bad debt problems. Prakrom said the number of out-patients at a state hospitals in Surat Thani jumped from 1,200 a day to more than 1,500. However, its monthly income declined from Bt19 million to only Bt16 million as patients had no money to pay.
28) The pricing programme will be available for private hospitals, particularly medium-class hospitals and those located upcountry.''An expectant mother will know the hospital's charge in advance, whether she will be treated for a natural birth or a birth by caesarian section,'' explained Prakrom.
29) According to Prakrom, the ministry will call a meeting with representatives of private hospitals wishing to participate in the programme to discuss ideas and calculate prices.
30) The new pricing system will be calculated using many pricing sources, including prices charged by private hospitals entering into social insurance, as well as the price list used in state hospitals.Private hospitals participating in the social insurance programme now charge 30 per cent more than state hospitals.Prakrom said the ministry will urge the government and the Board of Investment to review the plan to promote the establishment of private hospitals, especially in locations which are oversupplied.
HCFA Absolves Hospitals of Payments
(APW_ENG_19991018.0161)
1) *Associated Press Write
2) WASHINGTON (AP) -- The Clinton administration has decided to end attempts to recover millions of dollars from hospitals it had accused of overstating the amount of money the government owed them for providing care for the poor.
3) ``It became obvious that confusion regarding the issue was pervasive,'' Chris Peacock, a spokesman for the Health Care Financing Administration, which administers the payments, said Monday. ``This was the fairest thing to do for these hospitals which treat some of the nation's most vulnerable patients.''
4) The administration has been conducting a nationwide investigation of hospitals that receive so-called disproportionate share payments through the Medicare program because they treat large numbers of poor patients.
5) The review has focused on whether the hospitals had properly adhered to federal guidelines when counting patients for purposes of calculating their claims to the poverty payments.
6) Hospitals in some states had already been asked to begin repaying huge sums for alleged overpayments going back as far as a decade. Hospitals in New York, for example, were estimated to owe an estimated $1 billion, Pennsylvania hospitals $250 million and New Jersey hospitals $288 million.
7) In dozens of other states, hospitals were still under investigation.
8) The administration's reversal came after members of Congress from affected states protested, saying that the payment rules were not clear and that hospitals should not be penalized for past errors resulting from confusion.
9) Also, first lady Hillary Rodham Clinton, a potential candidate in the 2000 race for a New York's Senate seat, has said she believes hospitals caring for the poor deserve more federal money.
10) Administration officials began notifying lawmakers last week that hospitals that have already returned some money will get it back and that no further repayments will be required. The administration will also clarify the eligibility rules for the poverty payments, officials said.
11) Specifically at issue is whether hospitals can count patients qualifying for state public assistance programs but not the national Medicaid health insurance program for the poor.
Flu bug, elective surgeries jam N.J. hospitals
(APW_ENG_20000107.0181)
1) An empty bed is hard to find in a New Jersey hospital these days.
2) A combination of a virulent flu bug sweeping the region and a glut of patients who put off elective surgery until after the holidays is jamming hospitals throughout the state.
3) As a result, most hospitals have had to close their doors temporarily to new patients until beds open up. That, in turn, forces ambulances to divert emergency patients to other hospitals.
4) Waits of two hours or more just to see an emergency room doctor are common, officials say, and in some hospitals, for every patient in an upstairs bed, there's another one in the emergency room waiting for one.
5) "We've had times when we were the only hospital in our county that was not on bypass," said Dr. Jay Kaplan, chief of emergency medicine at St. Barnabas Medical Center. "We've had times where we were getting ambulances from 30 minutes away."
6) The situation was much the same at the 527-bed Monmouth Medical Center in Long Branch.
7) "For the first three days of this week, we were the only hospital in Monmouth County that was not on divert," said Dr. Peter Valko, Monmouth's chief of emergency medicine. "We were the only game in town for several days."
8) The New Jersey Hospital Association surveyed its 108 members last week, and found that virtually all of them had been forced to stop taking new patients for at least a few hours at a time, a practice known as "going on divert."
9) It happens when a facility's emergency department determines it cannot handle any additional patients because there are no available beds. The condition usually lasts a few hours until some beds open up, although some facilities have remained on divert for several days at a time.
10) "It really is difficult when everybody is going on divert because where are the emergency cases going to go?" asked Geri Moon, the hospital association's vice-president of professional practice.
11) "Hospitals have disaster plans in place, and this is almost like a mini-disaster, if you will," added association spokesman Ron Czajkowski.
12) While there have been no reports of emergency patients worsening because they had to be taken to a more distant hospital, hospitals take that step only as a last resort. And Kaplan said ambulance crews will still bring a critically injured or ill patient to the nearest emergency room, regardless of whether a divert order is in place.
13) "They're trying to do the best they can," Moon said. "They're bringing in additional staff, asking staff to work double shifts, and trying anything else they can to deal with the crush."
14) The situation is not likely to improve anytime soon.
15) January is always the busiest month for New Jersey hospitals, with seasonal flu outbreaks in full bloom. And many patients who need elective or non-emergency procedures such as gall bladder surgery or hernia repair usually schedule them for after the holidays.
16) That all adds up to jammed emergency rooms, and long waits for a hospital bed.
17) "There is a real focus on seeing people, even if we have to do it in the hallway," said Kaplan, whose St. Barnabas system includes 11 northern and central New Jersey hospitals. "They'd rather be seen in the hallway than not seen at all. I'm aware of some facilities that are holding as many patients in the ER as they have beds in the hospital."
18) Pati Caldwell, a spokeswoman for Jersey Shore Medical Center in Neptune, said her 502-bed facility was handling the overflow from other shore area hospitals. And even Jersey Shore had to go on divert twice this week.
19) The hospital usually treats 140 emergency room patients a day, but is averaging 25 to 30 additional ones this week, most of whom have flu or other upper respiratory ailments.
20) "Over the weekend and in the beginning of the week, we were totally jammed, and we're as busy today as we were then," she said. "We were receiving not only our own patients, but also patients from other hospitals that were on divert. We're pretty crowded, and it's been pretty steady."
Satellite ERs Saving Emergency Care
(APW_ENG_20000522.0022)
1) It's an emergency endangering many American hospitals: With shorter patient stays and a surge in outpatient treatment, more and more of the nation's 840,000 hospital beds stay empty.
2) The problem, exacerbated by shrinking reimbursements and rising technology and labor costs, has put hundreds of hospitals on life support. Many executives and trustees reluctantly are concluding the only cure is to cut vacant beds and acute-care services, killing emergency medical care.
3) So New Jersey, with its hefty surplus of beds, is encouraging hospitals closing -- or converting acute-care wards into outpatient clinics or rehabilitation or diagnostic centers -- to keep open ''satellite'' emergency rooms.
4) ''I do believe we're rather unique in the country ... in trying to create this step-down ER, if you will, to allow communities where a hospital is closing to retain emergency services,'' said Marilyn Dahl, New Jersey's head of health planning and regulation. ''In some states, hospitals just close.''
5) The satellite emergency rooms must be part of a system with nearby acute-care hospitals. They will be required to have staff and equipment to handle about 90 percent of typical emergency room cases, and stabilize patients requiring transfer elsewhere. Ambulance squads will go straight to a full-service hospital with any patients requiring hospital admission.
6) At least four hospitals or health care systems in the state already are pursuing such arrangements. The state is requiring some to do so, drafting regulations for the new emergency rooms, even creating a debt relief fund for some hospitals making the transition. A health department advisory board voted last week to publish the draft rules for public comment.
7) ''It's just the opposite of ''Not In My Back Yard'' -- everybody wants it,'' said George Gennaoui, spokesman for South Jersey Health System.
8) Hospitals closing has become such a problem in rural communities that the federal government four years ago created new regulations with a more-generous reimbursement structure for ''critical access hospitals.'' The facilities, which must be at least 35 miles from a major hospital, switch their focus to primary care but maintain an emergency department and a few short-term beds.
9) There's already about 110 of them around the country and another 300 of the nation's 6,000 hospitals may convert soon, said Kurt Patton of the Joint Commission on Accreditation of Healthcare Organizations. He thinks the conversion trend will slowly increase, but said New Jersey's approach is unique.
10) With the state aiming to eliminate excess acute-care beds so New Jersey's many financially strapped hospitals can recover, Gov. Christie Whitman has proposed an $8 million fund to help hospitals closing acute-care services reduce bond debt. Just last November, a commission on the future of hospitals issued a report recommending 30 percent to 50 percent of New Jersey's 25,620 acute-care beds be closed.
11) Fifty years ago, New Jersey had more than 51,000 hospital beds. That dropped to 31,264 by 1984 and keeps declining due to managed-care pressures, the advent of minimally invasive surgery, more home care services and other health care changes.
12) Last August, Memorial Medical Center at South Amboy abruptly closed amid mounting financial losses. A citizens committee and a new chief executive officer, Jim Monahan, campaigned to reopen it. Under an agreement reached with the state allowing it to reopen but not as a provider of acute care, Monahan said Memorial is negotiating with another hospital to help run a satellite emergency room and possibly other services.
13) Such arrangements may quiet community opposition to change, but hospital donors, volunteers, and staff members losing their jobs may remain angry, conceded Jean Marshall, a Meridian Health System vice president.
14) Last month, it closed acute-care services at one of its four Shore-area hospitals and -- under state orders -- converted Point Pleasant Hospital to New Jersey's first satellite emergency room. It meets proposed regulations for such operations, even though it will be months before they are finalized.
VA Hospitals Solid in Heart Care
(APW_ENG_20001227.0692)
1) Veterans hospitals don't deserve their reputation as inferior, at least when it comes to treating heart attack victims, a study found.
2) Researchers at the Houston Veterans Affairs Medical Center found that although the VA patients were sicker than Medicare patients taken to private hospitals, the same percentages in each group, 68 percent, were still alive a year after a heart attack. At one month afterward, 82 percent of the patients in each of the two groups were still alive.
3) ``It is pleasantly surprising,'' said Dr. Rohit R. Arora, chief of cardiology at the University of Medicine and Dentistry of New Jersey in Newark. ``The VA patient population will be less afraid to go to the VA for care.''
4) Dr. Laura A. Petersen, who led the study, she said more research is needed on how well VA hospitals do in providing other types of care.
5) The Veterans Affairs Department operates the largest U.S. health care system, with 139 hospitals serving 3.5 million veterans annually, many of them poor and elderly.
6) The system has been dogged by criticism dating back at least two decades, when a congressionally mandated study found that the quality of care was often poor. Other, small studies have promoted the belief that VA hospitals are inferior.
7) Houston VA researchers and colleagues at medical schools and hospitals examined the records of men 65 and older taken to hospitals for a heart attack. The study involved 2,486 veterans treated at 81 VA hospitals nationwide and 29,249 Medicare patients treated at 1,530 non-VA hospitals in seven states.
8) The researchers expected to find higher death rates among the VA patients, but found virtually identical rates.
9) The research was reported Thursday in the New England Journal of Medicine.
10) The VA patients were slightly more likely to have serious medical conditions, such as diabetes, asthma, high blood pressure, stroke or Alzheimer's disease. Their hospital stays averaged 14 days, compared with 10 for Medicare patients.
11) Petersen and Arora said that is probably because VA doctors do not feel the same pressure to discharge patients as those in nongovernment hospitals.
12) In an accompanying editorial, Dr. Stephen D. Fihn of the Veterans Affairs Puget Sound Health Care System said that the VA has made great strides in its 5-year-old effort to reorganize and improve quality.
Hospital Overloads Becoming a Worry
(APW_ENG_20010112.0691)
1) Hospital cutbacks and closings coupled with nurse shortages are forcing more and more overcrowded emergency rooms around the country to send ambulances elsewhere.
2) The hospitals do not have enough ER staff or beds to handle the crush.
3) Health care officials say no one in critical condition is being turned away, and other patients are simply being directed to other hospitals nearby. But they worry what could happen if the crunch gets any worse.
4) ``We're dealing with lives. It's not like we're selling widgets,'' said Brian Connor, president of the Massachusetts Ambulance Association.
5) When a hospital goes on diversion, as it is known, it puts out the word to emergency services, so that ambulance drivers and their passengers do not have to wander from hospital to hospital.
6) Walk-in patients are still being treated, but many of them are waiting hours to be seen, and then waiting in the ER some more until a bed opens up somewhere in the hospital.
7) ``The kind of complaint we hear is, `Yes, I got the care, but they had to put me in the hallway on a gurney for two hours,''' Pennsylvania Department of Health spokesman Richard McGarvey said.
8) Nearly all hospitals have to divert patients from time to time, particularly in the winter, which is the season for colds and flu, as well as chest pain and heart attacks from shoveling snow. But the problem appears to be happening more often, earlier in the season, and over broader areas than usual.
9) In Delaware County, outside Philadelphia, all seven county hospitals were full Monday night and went on diversion. In the Harrisburg area, all five hospitals had to divert patients for most of three days last week.
10) ``We're not even in the flu season yet. I think, come the end of this month, we're going to be in a crunch again,'' said Cynthia Ehlers, president of the Harrisburg area's Emergency Health Services Federation.
11) Experts attribute the problem in part to long-term changes in the health-care industry.
12) In the past 10 years, more than 1,000 hospitals and 1,100 emergency rooms in the United States have closed, and others have had to cut back because of diminished payments from Medicare and managed-care plans.
13) Add to that a severe nationwide shortage of nurses, and an aging population that is starting to require more hospital care.
14) In November, Cleveland hospitals set a third straight monthly record when eight hospitals went on diversion 57 times. With hospitals filling even before flu season, Cleveland and Cincinnati authorities last month proposed opening ``treat and release'' clinics in recreation centers or schools for flu patients.
15) In Boston, the area's 27 emergency rooms shut down for a total of 631 hours in November _ nearly twice the 386 hours that ambulances were diverted in October.
16) In Buffalo, N.Y., hospitals have reported keeping patients in emergency rooms, sometimes for more than 24 hours, until beds in intensive care or other floors open up.
17) Similar situations are being reported in cities such as Seattle, Tucson, Ariz., Los Angeles and New York.
18) ``It places horrendous tension and stress on emergency medical technicians and paramedics that now have to shop around and find a hospital,'' Connor said. ``And the tension we feel on the street is probably nothing compared to what doctors and nurses feel.''
19) Calling the recent overloads a wake-up call, Pennsylvania health authorities scheduled a series of working groups to look at the problem and come up with solutions. Others say a broader solution is needed.
20) ``It's like the highway system, which was pretty much ignored and fell into disrepair until federal and state governments decided they needed to rebuild the infrastructure,'' said Dr. Michael Carius, emergency room physician at Norwalk Hospital in Connecticut and president-elect of the American College of Emergency Physicians.
21) ``We've put health care on the back burner for so long, it's going to take a massive commitment to say, `We have to have more beds, better-equipped hospitals _ a system that meets the needs of the population.'''
Report: ER Crowding Is a Problem
(APW_ENG_20010315.0819)
1) Visits to emergency rooms are booming even as hospitals are closing, raising fears that some patients may not get urgent care as fast as they need it, the American Hospital Association reported Thursday.
2) The report comes as no surprise to many cities that for more than a year have reported ER crowding so bad that hospitals routinely divert ambulances to competing emergency rooms. The situation reached a crisis last winter when ERs around the country overflowed with flu patients.
3) But the hospital trade group suggests the crowding may only worsen because of financial problems. Federal law requires hospitals to care for patients who come to emergency rooms. But there is no federal program to reimburse hospitals for the care of poor, uninsured people. Additionally, Medicaid reimbursement is low for emergency services and managed-care plans sometimes deny payment for ER visits, the report says.
4) Emergency room visits rose by 15 percent in the 1990s, hitting 99.5 million in 1999, the AHA reported. One of every five Americans has been to the ER at least once, visits accounting for 40 percent of all hospital admissions, the report says.
5) Yet the number of emergency departments dropped as 493 hospitals, particularly in rural areas, closed between 1990 and 1999, the report says.
6) Also, existing hospitals have cut the number of beds. So if intensive care beds are full, those patients stay in the emergency room, which can't accept as many incoming patients _ the main reason for ERs diverting ambulances to other hospitals, the report says. It cited an informal survey suggesting two-thirds of hospitals ordered ambulance diversions in the last year.
Hospitals Cited for Patient Dumping
(APW_ENG_20010712.0930)
1) More than 500 hospitals were cited for illegally sending patients with emergency conditions to other hospitals in the late 1990s, according to a report from a public interest group.
2) The practice, called patient dumping, is a way for hospital emergency rooms to get rid of poor patients who have no health insurance.
3) Most of the 527 hospitals named in the research project conducted by Public Citizen were cited for breaking a law that guarantees patients the right to be treated at the nearest available hospital.
4) They were fined by the Health Care Financing Administration between 1997 and 1999, according to the report, which was released Thursday.
5) ``It's distressing that this law has been in place for 15 years, and hospitals are still flaunting it,'' said Dr. Sidney Wolfe, director of Public Citizen's Health Research Group. ``The government needs to do more to force hospitals to comply. People shouldn't be denied desperately needed emergency medical care when they go to a hospital. Failing to impose fines on most hospitals violating the law amounts to an invitation to dump sick patients.''
6) About 72 percent of the violating hospitals were not-for-profit hospitals, according to the report. About 19 percent were for profit. The status of 8 percent of the hospitals was not known.
7) Rick Wade, a spokesman for the American Hospital Association, said the report doesn't indicate a serious problem.
8) ``We have a million visits to the (emergency room) every year,'' Wade said. ``We have 5,000 hospitals in this country. The numbers (Public Citizen) is reporting are not significant and do not reveal any sort of trend. There has never been any evidence that patient dumping is rampant.''
9) The report concludes that a patient's insurance status likely influences hospital's compliance with the law.
10) Citing a case in New York, the report alleges that several uninsured patients in an emergency room were told by doctors that they would have to pay a fee before receiving a screening exam.
11) In another case, a patient arrived at an emergency room complaining of seizures. The patient's pulse, respiratory rate, blood pressure and temperature were taken. Despite a rapid heart rate, the patient was discharged with prescriptions for anti-seizure medication. He had a heart attack the next day. An autopsy revealed the attack was brought on by a severe case of pneumonia.
12) It was unclear whether the patient had insurance.
13) Wade said that many of the violations do not reflect malice by hospital staffs.
14) ``There are all sorts of reasons that a hospital could be cited for breaking the law that do not mean the hospital intentionally turned away a patient,'' Wade said. ``In some cases, the emergency room may misread the seriousness of the illness. This is a human process and there is human error. Hospitals work everyday to reduce the possibility for error.''
15) Public Citizen also concluded that the fines administered by the federal government are not big enough to make hospitals change their ways. The fine amounts generally do not exceed $50,000 per violation.
16) ``The sad truth is that it's cheaper for a hospital to break the law and pay a fine than to treat an uninsured patient,'' Wolfe said. ``Hospitals know that the risk of getting caught is low, and even if they are caught, the risk of being fined is even lower and the fines are minuscule compared to hospitals' operating budgets.''
Lung Cancer Hospitals Studied
(APW_ENG_20010718.1271)
1) In the latest medical study showing experience counts, researchers found that lung cancer patients survive longer if they have surgery at hospitals that do the operation frequently.
2) Patients treated at such ``high-volume'' hospitals also had far fewer complications and went home a day or two faster.
3) ``Expertise and experience probably improves not just the surgery, but the care before and after,'' said Dr. Peter P. Bach, a lung specialist and professor of epidemiology at Memorial Sloan-Kettering Cancer Center in New York.
4) Studies of heart surgery and treatments for a variety of other medical conditions likewise have shown that practice makes perfect. However, earlier studies on lung surgery followed patients only briefly.
5) In the latest study, researchers at Sloan-Kettering looked at 2,118 patients who had lung cancer surgery at 76 U.S. hospitals from 1985 through 1996. Most had an early stage of the most common lung cancer, non-small-cell lung cancer.
6) Doctors at the 34 lowest-volume hospitals performed only one to eight of the operations each year on average, while those at the two highest-volume hospitals did 67 to 100 annually.
7) The patients were followed for five years on average. Of those treated at the highest-volume hospitals, 44 percent survived five years and only 3 percent died within 30 days. At the lowest-volume hospitals, only 33 percent lived five years and 6 percent died within a month.
8) Forty-four percent of patients at the lowest-volume hospitals had complications, compared with 20 percent at the highest-volume hospitals.
9) Patient survival rates were higher at teaching hospitals than at nonteaching ones.
10) The research was reported in Thursday's New England Journal of Medicine.
11) Some researchers suggest that lung cancer operations be limited to hospitals with the best records, but Bach disagreed. And Kate O'Brien, an epidemiologist with the American Cancer Society, said such a practice would harm the quality of care.
12) She said the society is trying to determine which factors bring the best results, to help all hospitals improve.
13) Lung cancer, America's top cancer killer, strikes about 170,000 people and kills nearly as many each year. About one in five patients has surgery to remove some or all of a lung.
A breakdown of AP's count of Iraqi civilian deaths With BC-ME-GEN--Iraq-Counting the Dead
(APW_ENG_20030610.0706)
1) At least 3,240 civilian deaths were recorded by hospitals in Iraq as a result of the recent war. Associated Press reporters visited 60 of the country's largest hospitals to review those records.
2) Here is a list of the 3,082 civilian fatalities in key cities: _ Baghdad: 1,896 (recorded at 24 hospitals) _ Najaf: 293 (four hospitals) _ Karbala: 200 (one hospital) _ Mosul: 118 (five hospitals) _ Samawa: 112 (two hospitals) _ Nasiriyah: 145 (three hospitals) _ Fallujah: 89 (one hospital) _ Madain: 71 (one hospital) _ Diwaniya: 61 (one hospital) _ Kut: 52 (two hospitals) _ Tikrit: 45 (one hospital)
3) An additional 158 fatalities were scattered among many small villages and towns and cities.
4) In Basra, Iraq's second biggest city, hospitals issued 413 death certificates and officials estimated 85 percent were for civilians, but the hospitals did not keep daily records listing civilian or military status of casualties. The AP did not include any Basra deaths in its count.
Bush administration won't require emergency rooms to ask patients their citizenship status
(APW_ENG_20041002.0004)
1) The Bush administration is backing off plans to require hospitals to ask emergency room patients their immigration status, after hospitals and advocates for immigrants protested.
2) The hospitals and immigrant groups said the questions would make people afraid to seek care and lead to serious public health problems.
3) Last year's Medicare prescription drug law includes $1 billion over four years for hospitals that treat undocumented immigrants and absorb most of the cost of that care. A proposal developed over the summer said the hospitals would have to ask about citizenship and how people entered the country to make sure the new federal money was being spent on emergency services for undocumented aliens.
4) That prospect gave rise to a torrent of criticism that people would stay away from emergency rooms rather than provide information that could be used against them in deportation proceedings, despite the administration's insistence that the answers would not be used that way.
5) Dr. Mark McClellan, administrator of the federal Centers for Medicare and Medicaid Services, said Friday that public health concerns helped lead him to decide to determine eligibility in other ways.
6) "As a result of these pending changes, providers will not be asked _ and should not ask _ about a patient's citizenship status in order to receive payment under this program," McClellan said in a letter to hospital and advocacy groups.
7) Among the suggestions made to the administration was to collect documentation _ Social Security numbers, foreign driver licenses _ that taken together indicate immigration status. McClellan said new rules would be issued soon.
8) The National Association of Public Hospitals and Health Systems, representing more than 100 safety-net hospitals that treat many undocumented immigrants, said the original proposal would create "peril for those individuals, a public health threat to the entire community, and higher costs for treating patients at later disease stages."
9) California, Texas, Arizona, New York, Illinois and Florida are in line for the largest shares of the money.
10) Federal law requires hospitals to care for anyone who walks through their doors. The costs of such care have forced many hospitals, especially those in border communities, to close their doors or reduce service.
11) The House rejected legislation from Rep. Dana Rohrabacher, a California Republican, in May that would have explicitly required hospitals to determine immigration status, leading to deportation proceedings against people in the country illegally.
U.S. government lets public know how hospitals perform when treating heart patients
(APW_ENG_20070621.1622)
1) The U.S. government gave hospitals around the country a public report card that measures their performance in the treatment of patients suffering from heart attacks or heart failure.
2) Officials took a conservative approach in scoring the nation's nearly 4,500 hospitals. Almost all performed at the national average when it came to their patient mortality rates.
3) However, for heart failure, 38 hospitals were listed as performing better than the national rate for heart failure, and 35 were listed as performing worse. For heart attacks, 17 performed better; 7 worse. The ratings are based on hospital claims data filed from July 2005 to June 2006.
4) Health and Human Services Secretary Mike Leavitt said Thursdray that posting the hospitals' performance meets the administration's goal of helping consumers know what they're getting for their health care money.
5) "People need to know not only what their health care costs, but how good it is," Leavitt said.
6) At the same time, the ratings will also spur hospitals to take steps to improve their ratings.
7) "It really wasn't an attempt to embarrass hospitals in any way, shape or form," said Herb Kuhn, deputy administrator at the Centers for Medicare and Medicaid Services.
8) The rating took into account each hospital's mortality rate, but it also incorporated other factors, primarily each hospital's patient mix. For example, some hospitals see more elderly patients or more patients with diabetes than their competitors. So their rating takes that sicker patient mix into account.
9) Nationally, the 30-day death rate from heart attacks is about 18 percent. For heart failure, it is about 11 percent.
10) Medicare officials said hospitals have already been notified of their ratings, and were given much more detailed information than what is being made available to the public. Quality improvement officials will work with the hospitals performing worse than the national average.
11) An earlier attempt some 20 years ago to measure hospital mortality rates foundered when hospitals questioned the methodology. It took many years for health care providers, consumer groups and government officials to agree on a set of measures that all could support.
12) Rich Umbdenstock, president and CEO of the American Hospital Association, said hospitals strongly back the government's effort to give consumers information about the quality of care provided. Some of those hospitals that performed poorly with heart patients have had questions about the rating system.
13) "They are very grateful to have the information so they know what they need to focus on," Umbdenstock said.
Report: Woman miscarries after ambulance crash in Japan
(APW_ENG_20070829.0886)
1) A pregnant woman miscarried in western Japan on Wednesday after nine hospitals refused to admit her and the ambulance crashed on its way to the 10th, news reports said.
2) The incident triggered an immediate outcry in Japan, where the government has promised to improve medical care for expecting mothers as it struggles to reverse a declining birth rate. Last year, a pregnant woman from the same area died after being refused admission by about 20 hospitals that said they were full.
3) In Wednesday's incident, the 38-year-old woman, who was in the sixth month of her pregnancy, was being driven to a hospital near the western city of Osaka after she suffered from stomach cramps and bleeding, according to Kyodo News agency and other local media.
4) Nine hospitals closer to her home in Nara prefecture (state), over 40 kilometers (25 miles) away, had earlier refused to admit her, saying they were full, the reports said.
5) Her water broke two hours into the journey. Ten minutes later, the ambulance collided with a minivan.
6) She was transferred to another ambulance and reached the Osaka hospital three hours after she first contacted emergency services, Kyodo reported. Her baby was pronounced dead on arrival at the hospital, according to the reports.
7) "This is a very grave incident," Heath Minister Yoichi Masuzoe told public broadcaster NHK late Wednesday. "The Health Ministry will conduct a thorough investigation," Masuzoe said.
8) Police were quoted as saying they were not sure the accident caused the woman's miscarriage. The woman and ambulance staff were not injured in the accident.
Foreign woman rejected 7 times by hospitals in western Japan after childbirth
(APW_ENG_20070927.0457)
1) A foreign woman seeking medical help in Japan after giving birth at home was rejected by five hospitals where officials said her Japanese wasn't good enough and they didn't have proper facilities, authorities said Thursday.
2) The woman, in her 20s, was finally admitted to one of the hospitals after begging to be treated over two hours, during which two of the hospitals rejected her twice, said Takaaki Uchida, an official in Tsu, 317 kilometers (198 miles) southwest of Tokyo.
3) All of the hospitals were equipped with maternity wards, but only two had intensive care units for newborn babies.
4) The incident happened in August 2006, but was reported in Japan on Thursday in the wake of the case of a 38-year-old woman who suffered a miscarriage last month after ten hospitals refused to admit her and her ambulance collided with another car.
5) The cases have raised concerns about shortcomings in emergency care for pregnant women, an growing worry as Japan grapples with declining birthrates -- among the lowest in the world -- and a burgeoning elderly population.
6) Uchida said the hospitals claimed the woman, whose name and nationality was withheld by officials, couldn't speak Japanese well enough for them to communicate with her, and that they didn't have emergency facilities to care for her newborn boy.
7) The woman had never consulted a doctor at a maternity clinic during her pregnancy, a fact that also made it difficult for her to find a hospital, Tsu City fire official Yoshinobu Sakurai said.
8) Sakurai also said the woman could not speak Japanese at all and her female companion to the hospital also spoke only broken Japanese.
9) Both the mother and the baby boy were healthy, according to Sakurai.
10) Following the miscarriage case, on Aug. 29 incident, the government has ordered local governments to review past cases of transporting pregnant women.
11) Last year, a pregnant woman in western Japan died after being refused admission by about 20 hospitals that said they were full.
Survey finds Japanese hospitals rejected 14,000 emergency patients in 2007
(APW_ENG_20080311.0610)
1) More than 14,000 emergency patients were rejected by hospitals in Japan at least three times before getting treatment in 2007, a government survey said Tuesday.
2) The results of the survey came amid frequent reports in Japan of patients being rejected because doctors are not available or hospitals lack adequate facilities.
3) At least 3.5 percent of cases in serious condition were rejected three times or more by hospitals, according to a compilation of reports by ambulance workers conducted by the Fire and Disaster Management Agency.
4) "The results were more severe than we'd imagined," said Toshimi Koitabashi, an official with the disaster management agency.
5) In the worst case, a woman in her 70s who had trouble breathing was rejected 49 times in Tokyo, Koitabashi said.
6) It was unclear what happened to the elderly woman -- or any other of the patients in the survey -- because the agency did not investigate what happened to these patients after they were taken to hospital, he said.
7) Of the 411,625 patients in serious condition whose cases were reviewed, 14,387 were rejected more than three times by hospitals, according to the survey. A serious condition was defined as meaning the patient would need more than three weeks of hospitalization.
8) Patients were rejected because hospitals and clinics did not have enough staff or adequate facilities, according to the survey. Hospitals also said their beds were full.
9) Hospitals in large cities such as Tokyo and Osaka rejected patients more often than those in smaller cities, the survey showed.
10) Koitabashi said his agency and the Health Ministry will hold a meeting of local officials to discuss the problem.
11) "We want local governments to look into a better system to accept emergency patients," he said.
12) The survey underscores Japan's health care woes, in part created by a shortage of doctors in the country's rapidly aging society.
13) In some cases, patients have died while waiting for care.
14) In December, an 89-year-old woman died after an ambulance crew spent two hours trying 30 hospitals before finding one that would accept her for treatment.
Doctors ' strike shuts down hospitals in Nepal ' s capital
(APW_ENG_20080709.0319)
1) Nepalese doctors walked off the job Wednesday, shutting down hospitals and clinics in the capital to pressure the government to protect them against attacks by angry relatives of patients who have died.
2) Dr. Kedar Narsingh of the Nepal Medical Association said all private and government hospitals were closing for one day to protest the government's failure to provide security for doctors and medical staff.
3) Emergency services remained open, he said.
4) There have been several incidents in the past year in Nepal where patients have died, and their family members have attacked or threatened hospitals and doctors, alleging negligence in their relatives' death, according to Narsingh.
5) Emergency services at the hospitals would still be running on Wednesday, he said.
6) In the latest incident, the family of a patient who died after kidney surgery threatened doctors at a hospital in Katmandu over the weekend.
7) Narsingh said the government had promised better security at hospitals two years ago after a similar incident led to a doctors' strike, but little has been done.
Report: Economy is sickening US hospitals
(APW_ENG_20081120.0096)
1) The dismal economy has American hospitals ailing, with new data showing declines in overall admissions and elective procedures, plus a significant jump in patients who can't pay for care, the American Hospital Association said Wednesday.
2) Hospitals also have been hurt by losses on their investments due to the turmoil on Wall Street, and many are finding it more expensive to borrow money -- if they can at all, according to a report from the association, which represents about 5,000 U.S. hospitals.
3) "The worst part is the combination of all of the above," said Rich Umbdenstock, the association's president and chief executive.
4) Some of the hardest-hit hospitals began reducing staffing and services as early as last spring and more will follow, although hospitals are trying to limit the impact on patients, said Umbdenstock. He said hospitals are more likely to eliminate entire services -- money-losers or ones with high operating costs -- than to make across-the-board cuts that weaken all services.
5) "There have been hospital closures (this year), particularly in some of the more heavily impacted areas," such as New Jersey, where hospitals are providing more and more unreimbursed care, he said.
6) The downturn is hitting hospitals worse than other industries, he said, and many already were struggling due to pressures including government programs such as Medicare and Medicaid not paying the full cost of treatment. Hospitals are worried the Obama administration's health care reforms will affect reimbursement rates for those two huge programs, which cover 55 percent of all hospital patients.
7) A hospital association survey about conditions over the past three months drew responses from 736 hospitals, and the association report also uses figures from the July-September period collected from 557 hospitals that send quarterly reports to a central system run by the Colorado Hospital Association.
8) The Databank hospitals' investment results amounted to a combined loss of $832 million, compared with a $396 million gain a year earlier -- a big problem because normally investment gains help make up for some of the costs not covered by patients and insurers.
9) Meanwhile, the interest those hospitals paid on borrowed funds jumped by 15 percent in the third quarter, compared to 2007's third quarter, another difficult squeeze because hospitals generally borrow money for expansions and upgrades, multimillion-dollar technology and even sometimes to cover payroll and pay regular vendors.
10) Other key findings:
11) --67 percent of hospitals saw some drop in elective procedures; 6 percent saw a significant drop.
12) --63 percent saw some decline in overall admissions; 9 percent saw a bigger drop.
13) --Inpatient and outpatient surgeries and emergency department visits were all down roughly 1 percent in the third quarter.
14) --Half of hospitals have seen a moderate or significant jump in uncompensated care, with a jump averaging 8 percent. The association cites unemployed people losing their health insurance.
15) --Total profit margin at the Database hospitals dropped from an average 6.1 percent in 2007's third quarter to an average loss of 1.6 percent in 2008's third quarter.
16) --56 percent of hospitals are reconsidering or postponing renovations or expansions, and about 40 percent are delaying improvements to information technology or other equipment.
Injured man dies after rejection by 14 hospitals
(APW_ENG_20090204.0418)
1) A 69-year-old Japanese man injured in a traffic accident died after paramedics spent more than an hour negotiating with 14 hospitals before finding one to admit him, a fire department official said Wednesday.
2) The man, whose bicycle collided with a motorcycle in western city of Itami, waited at the scene in an ambulance because the hospitals said they could not accept him, citing a lack of specialists, equipment, beds and staff, according to Mitsuhisa Ikemoto.
3) It was the latest in a string of recent cases in Japan in which patients were denied treatment, underscoring the country's health care woes that include a shortage of doctors.
4) The man, who suffered head and back injuries, initially showed stable vital signs, but his condition gradually deteriorated. He died from hemorrhagic shock about an hour and half after arriving at the hospital, Ikemoto said.
5) The motorcyclist involved in the Jan. 20 accident was hurt too and was also denied medical care by two hospitals before one accepted him, Ikemoto said. He was recovering from his injuries.
6) More than 14,000 emergency patients were rejected at least three times by Japanese hospitals before getting treatment in 2007, according to the latest government survey. In the worst case, a woman in her 70s with a breathing problem was rejected 49 times in Tokyo.
UN: some Haitian hospitals are charging patients
(APW_ENG_20100209.0122)
1) The United Nations warned Monday that it will cut off shipments of free medicine to Haitian hospitals that charge patients, saying it had learned some are levying fees for drugs.
2) When the catastrophic earthquake struck Jan. 12, authorities immediately decided to make all medical care free. More than 200 international medical relief groups have sent teams to help, and millions of dollars of donated medicine has been flown in.
3) U.N. officials told The Associated Press they had information that about a dozen hospitals -- both public and private -- had begun charging patients for medicine.
4) The officials said they could not immediately provide the names of the hospitals but said they were in several parts of the country, including Port-au-Prince.
5) "The money is huge," said Christophe Rerat of the Pan American Health Organization, the U.N. health agency in the region. He said about $1 million worth of drugs have been sent from U.N. warehouses alone to Haitian hospitals in the past three weeks.
6) Hospitals don't need to charge patients to pay their staff, because Haitian Health Ministry employees are getting paid with donated money, Rerat added.
7) U.N. officials said that beginning now, any hospital found levying fees for medicine will be cut off.
8) But they added the U.N. would consider continuing to supply non-governmental groups working at private hospitals hit with embargoes if the NGO can make a convincing case that none of the people it is treating are being charged.
9) A member of the special Haitian government commission created to deal with the post-quake medical crisis, Dr. Jean Hugues Henry, said he had no knowledge of any hospitals charging for services or medicine.
10) "Tomorrow, we will clarify that the government never gave anyone permission to charge for medicine and services," he said.
11) Haiti now has about 90 hospitals, including public and private hospitals and field hospitals set up in the quake's aftermath.