let me draw you a map

You’re uninsured, you break your leg. So you do what anyone else would do — you head to the nearest Emergency Department. But it’s a stable fracture, so the ED doc places a splint and tells you to follow up at the county hospital for further care. Urban legend? Or crappy reality?

Today the Chicago Tribune reports that non-profit hospitals in the Chicago area are doing just that — stabilizing patients then sending them for ongoing care at overcrowded Stroger Memorial, formerly known as Cook County hospital. I’ve talked with doctors and nurses in Seattle who routinely see the same thing — sick patients instructed to follow up at the county hospital who arrive in the ED with a mapquest printout of directions from one hospital to another.

One reason some folks are so upset over this is that non-profit hospitals enjoy significant tax breaks, to the tune of millions of dollars yearly, for supposedly providing charity care. Are they shirking their responsibility? Some of our elected officials think so and have spent years working to more strictly define exactly what ‘charity care’ means.

Like everything else in health care, though, the issue is more complex than it seems. Sometimes a hospital doesn’t have the right specialist to deal with your specific problem. That’s the rationale you hear most when a hospital declines to provide ongoing care. But a simple leg fracture? Even when a hospital has qualified specialists, some won’t see you without seeing your insurance card first, and others will still send you elsewhere if your insurance doesn’t pay enough to cover the cost of the operating room, staff, equipment, and supplies — let alone the doctor. In our area, it’s become more challenging to find doctors who will perform complex orthopedic procedures on patients with Medicare or Medicaid insurance, for example.

The downstream effect is that county hospitals are increasingly overloaded with uninsured or underinsured patients who need specialty care and procedures. As the Tribune story notes, Chicago now enjoys the highest sales tax in the country, partly to cover the costs of health care at Stroger. Tax inflation is exactly what we’ll all be facing as the burden on public hospitals continues to grow.

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