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NYT: Nowhere to Go, Patients Linger in Hospitals, at a High Cost


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Nowhere to Go, Patients Linger in Hospitals, at a High Cost

Hundreds of patients have been languishing for months or even years in New York City hospitals, despite being well enough to be sent home or to nursing centers for less-expensive care, because they are illegal immigrants or lack sufficient insurance or appropriate housing.

As a result, hospitals are absorbing the bill for millions of dollars in unreimbursed expenses annually while the patients, trapped in bureaucratic limbo, are sometimes deprived of services that could be provided elsewhere at a small fraction of the cost.

“Many of those individuals no longer need that care, but because they have no resources and many have no family here, we, unfortunately, are caring for them in a much more expensive setting than necessary based on their clinical need,” said LaRay Brown, a senior vice president for the city’s Health and Hospitals Corporation. Under state law, public hospitals are not allowed to discharge patients to shelters or to the street.

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You wonder what the tipping point has to be for this cluster**** to be significantly changed. Sometimes in working with horribly dysfunctional systems, the breakdown is so deep and widespread that there are not enough piecemeal interventions to ever remedy it to any meaningful degree. You reach a point where continued decline is gauranteed and increasingly destructive if you keep applying typical solutions (or, of course, ignore it)..

Then, an alternative is to blow it up dramatically, deliberately, (but not without thought to manner--- it's best to have some postive outcomes strategy) and take whatetever damage follows as part of the mending process needed, and rebuild to a more functional system.

It sounds radical because it is---lke amputaion. But in some (human and other) systems it actually can be of a lesser extent of damage and of notably lesser duration (obviously) than trying to do guesswork/patchwork repairs on a terminal system.

That kind of move in a complex context requires things like intelligence, courage, agreement, committment, strength, and integrity of motive to do properly. In our current poltcial climate. I guess that means we remain screwed, at least for awhile longer. :(

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When I had appendicitis, I didn't have insurance. I left the next day after my operation because my roommate had a non-specific infection. I was getting out of there, regardless if I had a place to go or not. I was in overnight, was operated on about 6pm and was released about 3pm the next day. I can't see hospitals letting people stay if they are okay to leave, just because they don't have insurance. You'd think they'd release them as soon as possible. This article doesn't make sense.

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