Rationing Access to Care to the Medically Uninsured
The Role of Bureaucratic Front-Line Discretion at Large Healthcare Institutions
Bibliographic Data
| ID | 9102982 |
|---|---|
| Authors | Saul J Weiner (0000-0002-5637-5392, University of Illinois Chicago, corresponding author), Margaret Laporte (University of Illinois Chicago), Richard I Abrams, Richard Abrams (Rush University), Arthur Moswin (Mercy Hospital and Medical Center), R B Warnecke (0000-0001-9045-2841, Institute for Women's Policy Research), Richard Warnecke |
| Year | 2004 |
| Volume | 42 |
| Issue | 4 |
| Pages | 306-312 |
| Publication date | 2004-04-01 |
| Peer Reviewed | Yes |
| Open Access | No |
| Type | ARTICLE |
| Venue | Medical Care (JOURNAL) |
| Journal identifiers | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Publisher | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/01.mlr.0000118706.49341.49 |
| PMID | 15076806 |
| OpenAlex | W2074513085 |
| Language | EN |
| Citations received | 12 |
| References cited | 5 |
BACKGROUND: Medically uninsured patients seeking nonemergency care are not guaranteed access to services at most healthcare institutions. They must first register with a clerk who could require a deposit and/or payment on an outstanding debt. OBJECTIVES: This study examines the factors that influence whether nonmedical bureaucratic staff sign in or turn away uninsured patients who cannot meet prepayment requirements. RESEARCH DESIGN: The study was conducted at a for-profit, a not-for-profit, and a public healthcare institution in a metropolitan area. The authors explored the relevant policy environment through interviews with senior administrators and a review of documents pertaining to the management of self-pay patients. Then they examined how policies affecting access were implemented through in-depth, semistructured, audiotaped interviews with 55 front-line clerical personnel. RESULTS: At all 3 institutions, policies were ambiguous about what to do when uninsured patients cannot afford required prepayments. Seventy-one percent of staff reported they do not turn patients away; the remainder stated that on occasion they do. A variety of rationales were provided for how decisions are made. Those with the lowest-level positions were significantly more likely to be sympathetic to indigent patients and less likely to report turning patients away. CONCLUSIONS: Consistent with other studies of front-line bureaucracies indicating that low-level personnel who interface with clients make discretionary decisions, particularly when organizations pursue potentially conflicting priorities, this preliminary investigation found that nonmedical personnel play a significant role in decisions affecting access to care for medically indigent patients
Business · Economic growth · Economics · Health care · Health care rationing · MEDLINE · Political science · Rationing · Healthcare Policy and Management · Healthcare Systems and Reforms · Medicine · Primary Care and Health Outcomes
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| Unique citing works | 12 |
|---|---|
| Citations per year | 0,55 |
| Citation span | 2004 - 2025 (22) |
| Citation velocity | recent |
| Highly cited | No |
| Citation types | Neutral: 12 |