Advocacy

Access to Health Care & Cost

Eva Chavez, MD, PGY-1
Case
WBN Mommy Call:
Early Saturday morning 3:15am
21 month old, previous 28 week preterm with CP, now with a
rash. Started earlier (<24 hours) on the face then progressed
to the trunk, now is all over the body.
He has been well except for recent diagnosis of AOM, he just
finished his last day of Amoxicillin
Denies any other symptoms including fevers, cough,
congestion, rhinorrhea, shortness of breath, no drooling or
trouble swallowing. No new medications, foods, soaps, etc.
Mom noticed his upper lip has some swelling, but talking
happily in the background
PMH: 28 week preterm, h/o Grade III IVH, spastic CP,
developmental delay.
Recent AOM
Imms: UTD
Social history: Hispanic family, patient was born unexpectedly
while family was visiting Mexico, therefore undocumented.
Patient has no insurance and family is a very low income family.
SMC patient on sliding scale for visits


Differential
Generalized Rash
Contact Dermatitis
Atopic Dermatitis
Drug Eruption
Urticaria
Varicella
Roseola
Viral Exanthem
HFMD
Fifth Disease
Kawasakis Disease
Meningococcemia
RMSF
Scarlet Fever
Staphylococcal
scalded skin
syndrome
Stevens-Johnson
syndrome
Measles
Toxic epidermal
necrolysis
Rubella
Rubeola
Allergic Reaction


Non-emergent rash, no concerning signs on questioning.
Dose of Benadryl given and followed up the next day.
At PCH ED
Uninsured Meet with Eligibility
Determine whether they qualify for Medicaid/CHIP/Other
If not Medicaid Eligible they receive 25% discount on the visit
Can also receive pre-service discount of additional 15% if they can
pay in full at time of service
If Medicaid/CHIP eligible they are responsible for the estimated
amount they would pay once enrolled
Eligibility works with family to help fill out paperwork for
Medicaid/CHIP/Other
Admission to PCH
Emergency Medicaid for Undocumented who
qualify
Financial Assistance Program through IHC
Charity
Non-profit organization Needs to meet a minimum of
charity work to maintain status

Cost Shifting
Hospital cost shiftingcharging private payers more in response to shortfalls in
public payments

How Much Do Hospitals Cost Shift? A Review of the Evidence - Austin B Frakt

Conclusions:
Review of literature since 96 shows that there is not strong
evidence that cost shifting is large and pervasive
Cost cutting, another response to shortfalls in public payments to
hospitals
Cost shifting may be higher in cases of uninsured patients. Higher
private premiums paid for providing services to the uninsured.
Estimates vary.
Cost Shifting
Insuring Children
~48,200 of Utahs uninsured are children from low-income families who
qualify for Medicaid or CHIP.
185,900 of the states uninsured live at or below 138 percent of the federal
poverty level and would qualify for Medicaid under an expansion of the
safety net program.


Insuring Children
Eligible for Medicaid/CHIP
Barriers to enrollment: education/awareness, stigma of welfare, paperwork, rural areas
Strategies to improve enrollment: Getting the word out through various outlets, single
application to determine eligibility for multiple programs, simplify enrollment policies
(those eligible for reduced/free lunch automatically start application for
Medicaid/CHIP), community organizations assisting, simplifying renewal policies

Voices for Utah Children
Insuring Children
Case - Rash
For emergencies direct to PCH
OSH and urgent care will likely not provide financial assistance
if not eligible
Non-emergent, direct to follow up with PCP or clinic the
following day
Options for uninsured include clinics such as Maliheh Free Clinic, Utah
Hope Clinic, Magna Exodus Clinic, 4
th
street Clinic, Community Health
Centers, Redwood Clinic, etc.
http://slcohealth.org/html/medicalresources.html
References
Frakt Austin B. How Much Do Hospitals Cost Shift? A Review of the
Evidence. Milbank Q.2011;89:90, 123. [PubMed]
Eligibility Office at PCH
Voices for Utah Children
Utah Health Policy Project
http://slcohealth.org/html/medicalresources.html
Health.Utah.gov