"New Amsterdam" Hospital (doctor, toddler, insurance, cancer)
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I just love this Netflix series and they reveal some hard truths about medical costs in it.
Of course, I know the hospital is fictional, but several times it is alluded to as being a "public" hospital where people can get treatment for "free" but no one realizes they don't have to actually pay. It's like a secret.
Are there public hospitals like this? In the U.S., I never heard of one.
County (Public) hospitals are hospitals set up with government funds to serve the underprivileged mainly those without insurance and on Medicaid. Anyone can use the hospital so it isn't exclusive to them but they are the default hospital for those who can not pay and are subsidized by government. Most are associated with medical schools and so it is a heavy teaching setting.
Some of the challenges of county hospitals are noted in the link below.
I just love this Netflix series and they reveal some hard truths about medical costs in it.
Of course, I know the hospital is fictional, but several times it is alluded to as being a "public" hospital where people can get treatment for "free" but no one realizes they don't have to actually pay. It's like a secret.
Are there public hospitals like this? In the U.S., I never heard of one.
I'll have to look up this series, sounds interesting.
There are many public hospitals in the US, these hospitals receive funding from local governments ( maybe state too, but I'm not sure of all the sources of their funding) to keep going as they treat indigent and other poor patients with no money and no insurance.
I've worked in a couple public hospitals, and the care there isn't really "free", someone bears the cost of treating patients who don't pay for their own care, either through their health insurance or out of pocket pays. Public hospitals, like all healthcare facilities, have heavy overhead and expenses that they are expected to cover, including building expenses ( utilities, specialized equipment, building maintenance), personnel salaries and benefits,,regulatory mandates with which they must comply, to name a few. If care at these hospitals was "free", they wouldn't have the money to cover their expenses, unless they received enough money from governmental sources and donations to pay for everything, and I think that's very unlikely, don't you?
From what I've seen, public hospitals make every effort to bill patients for their services. For patients with insurance, their insurance is billed, with patients billed for copays and deductibles. For patients without insurance, the hospitals' billing departments may offer a significant discount on the amount billed, and/or set up a payment plan so the patients can pay their bills over time. For patients who inform the hospitals that they have nothing, no money and can't pay their bills, the hospitals' social work departments may get those patients enrolled in "emergency medicaid", ***so the hospital can at least get some reimbursement ( may be pennies on the dollar,), but they rationalize it's better than nothing if the patients say they are broke and will make no effort to pay anything on their bills. We used to see this happen often in one hospital I worked in where the patients ( including immigrants who came to the US for treatment) came into the ER with serious illnesses, and the staff were more or less compelled to admit those patients for extended care.
The hospitals may send unpaid bills to collection agencies, ( these agencies buy these debts for a fraction of their amounts, so the hospitals aren't getting a fortune for those debts), and I know of at least one hospital that will put liens on the houses/properties of patients who haven't paid their debts. Which means that the hospital can collect on the lien when the property is sold. This would be done for people who have some money, or are homeowners, ie, have some net worth.
For patients with debt that the hospitals know do not own much, or anything, ( say they're homeless, or otherwise indigent, perhaps recently arrived immigrants), they might be billed or at least have biils for services on record, but fhe hospitals may not make any effort to collect any debt from these folks. They will most likely write off the debt ( as they would any financial losses) as losses on their income taxes.
****Guess who pays for the emergency medicaid? Thaaaaaat's right, Mr. and Ms. Taxpayer, ie, you and me!
I'm not familiar with the TV show, but my first reaction was to think not of County hospitals, but of facilities that were specifically set up to care for patients under the assumption that few, if any of them, would be paying directly. Specifically, St. Jude Children's Research Hospital and the several Shriner's Hospitals across the country. Those hospitals don't even charge patients directly to my knowledge, but I could be wrong about that.
I'm not familiar with the TV show, but my first reaction was to think not of County hospitals, but of facilities that were specifically set up to care for patients under the assumption that few, if any of them, would be paying directly. Specifically, St. Jude Children's Research Hospital and the several Shriner's Hospitals across the country. Those hospitals don't even charge patients directly to my knowledge, but I could be wrong about that.
This series was apparently based off a book (books) written by some doctor who worked at Bellevue hospital, a charity hospital. There is a British series called London Hospital that is about the Royal London Hospital, which is based on memoirs from that hospital. Bellevue does insurance for insured patients and I think it is like the standard county/city hospitals. They tend to be level 1 trauma centers (the most comprehensive) and are often the only hospitals in the area able to provide that level of care. In some ways, that makes sense since hospitals have to take everyone and ideally you’d rather end up at a place that is willing to work out payment plans or provide charity care than ending up at a for-profit hospital.
I'm not familiar with the TV show, but my first reaction was to think not of County hospitals, but of facilities that were specifically set up to care for patients under the assumption that few, if any of them, would be paying directly. Specifically, St. Jude Children's Research Hospital and the several Shriner's Hospitals across the country. Those hospitals don't even charge patients directly to my knowledge, but I could be wrong about that.
As I understand it, St. Jude Hospital doesn't charge for the care they give to their patients. But they are
heavily endowed with donations, and grants for their research, apparently enough to pay their expenses.
Something I learned about St. Jude hospital when I visited there with a group a number of years ago, was that the patients they agree to take on for treatment must have a diagnosis for which research is being carried out by their research department at the hospital. A patient with a rare cancer that isn't a current subject of research there will probably not be accepted there as a patient.
I worked in a pediatric hematology/oncology clinic for a number of years, and recall we had one patient, a toddler with what was probably megakaryocytic leukemia ( megakaryocytes are the bone marrow precursors of platelets- which break off from the cytoplasm of the megakaryocyte). This is a very rare form of leukemia, and unless times have changed, diagnosis is difficult, treatment is tricky, and patients don't survive very long. This little girl did poorly and her parents, desperate for help, applied to have her taken on by St. Jude for treatment. St. Jude turned them down, though I never learned the specific reasons they cited for doing so. I imagined that it may have been for any number of reasons, 1) perhaps her diagnosis was in question, 2) they weren't carrying out any research on her disease, and/or 3) she wasn't in good enough shape physically to make the trip from FL to Memphis, or go through outpatient treatment. St. Jude treats children primarily on an outpatient basis, they maintain some inpatient facilities to treat children who may get very ill or have a bad reaction to treatment and need those facilities on a temporary basis. But they don't have a lot of facilities to treat many children on an inpatient basis, and probably wouldn't accept such sick children who need more care than they can provide as outpatients.
Not familiar with Shriner's hospitals ( just the TV ads with the kids in it), but I imagine they are well endowed with donations and grants as well. Otherwise they couldn't offer their services for free.
This series was apparently based off a book (books) written by some doctor who worked at Bellevue hospital, a charity hospital.
Quote:
Originally Posted by SimplySagacious
The series was inspired by Bellevue, the oldest public hospital in the US.
Oh, well, if it's supposed to be based on Bellevue, then OP's question makes more sense to me now. To me, Bellevue is pretty much the textbook definition of a public hospital owned and managed by a County/State/Municipality.
Others large public hospitals that spring to mind are Cook County (Chicago), Ben Taub (Houston), Parkland (Dallas), Grady Memorial (Atlanta), Maryland Shock Trauma (Baltimore), USC/LA County (Los Angeles), and Harborview (Seattle). There used to be Charity Hospital in New Orleans, but it closed following Hurricane Katrina after the building was condemned (the building was old and decrepit even before then; it's still there, btw, they can't figure out how to tear it down without affecting the integrity of nearby buildings).
Last edited by Texas Ag 93; 04-14-2022 at 01:15 PM..
There is reality behind it though. I don’t know anything about NYC, but Cook County is a complete public health system with clinics and a lot of offerings. Optimally, most counties should have a county health department, but some states have cut them back drastically. When I worked for a state department of health, there was a scandal because they had dramatically cut back services at the same time we were having an increase in HIV and TB cases. I had a family member who worked part time as a provider at a clinic who was let go.
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