Access to primary care for patients with diabetes at an urban public hospital walk-in clinic.

The purpose of this study was to determine the regular source of primary care, the content of care, and barriers to accessing primary care for 218 medically indigent adults with diabetes mellitus. Patients were surveyed at a public hospital walk-in clinic and were queried regarding demographics, regular source of care, and the content of care they received during the preceding year. Seventy percent of the patients were medically uninsured, and 60 percent had household incomes under $10,001. Forty-three percent reported no regular source of care, and 18 percent named an episodic care site as their regular source. Patients with a regular source of primary care had twice as many annual ambulatory visits as those without primary care. Patients with a regular source of primary care reported more diabetic-related services than those without. This patient population is largely poor and uninsured and has difficulty accessing primary care.

Patient dumping. Status, implications, and policy recommendations.

KIE: Patient dumping, or the transfer of patients from private to public hospitals because of economic or social factors, is on the increase throughout the United States. Focusing on the dumping of patients by hospital emergency departments, the authors examine the economic, ethical, legal, and medical aspects of the problem. Although 22 states and the federal government have enacted statutes requiring hospitals to provide emergency care regardless of ability to pay and requiring that patients be stabilized before transfer to another hospital, Ansell and Schiff contend that even the best of these laws are deficient in defining such terms as "emergency" and "patient stability" and that monitoring and enforcement of existing laws and the guidelines of the American College of Emergency Physicians are inadequate. They propose a policy that no patient in need of emergency hospitalization should be denied admission or transferred for economic reasons.^ieng

Transfers to a public hospital. A prospective study of 467 patients.

In recent years there has been a dramatic increase in the number of patients transferred to public hospitals in the United States. We prospectively studied 467 medical and surgical patients who were transferred from the emergency departments of other hospitals in the Chicago area to Cook County Hospital and subsequently admitted. Eighty-nine percent of the transferred patients were black or Hispanic, and 81 percent were unemployed. Most (87 percent) were transferred because they lacked adequate medical insurance. Only 6 percent of the patients had given written informed consent for transfer. Twenty-two percent required admission to an intensive care unit, usually within 24 hours of arrival. Twenty-four percent were in an unstable clinical condition at the transferring hospital. The proportion of transferred medical-service patients who died was 9.4 percent, which was significantly higher than the proportion of medical-service patients who were not transferred (3.8 percent, P less than 0.01). There was no significant difference in the proportion of deaths on the surgical service between patients who were transferred and those who were not (1.5 vs. 2.4 percent). We conclude that patients are transferred to public hospitals predominantly for economic reasons, in spite of the fact that many of them are in an unstable condition at the time of transfer.