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1. Case study: A health care clinic for the uninsured faces the problem of treating illegal immigrants Laura Redmond Nursing 587 Drexel University 2. A Challenge to the…
  • 1. Case study: A health care clinic for the uninsured faces the problem of treating illegal immigrants Laura Redmond Nursing 587 Drexel University
  • 2. A Challenge to the System <ul><li>In September 2008, The Stuart Clinic choose to change policy and ask for citizenship status prior to treatment </li></ul><ul><li>Driven by increased costs and potential of losing secondary care agreements with hospital, local care offices </li></ul><ul><ul><li>Found it could not afford to provide the tests previously paid by Martin Memorial </li></ul></ul><ul><li>Both agreed to restrict care to legalized residents only </li></ul>
  • 3. A Challenge to the System <ul><li>Decision has far-reaching implications </li></ul><ul><li>Has the potential to influence the non-profit health care landscape </li></ul><ul><li>Should VIM institute a national policy change restricting care for illegal immigrants using additional eligibility requirements based on residency status </li></ul>
  • 4. Volunteers in Medicine (VIM) <ul><li>Started in 1992 in Hilton Head, SC </li></ul><ul><li>Currently, 200+ VIM clinics nationwide </li></ul><ul><li>Relies on donated time from volunteers and retired health care professionals </li></ul><ul><li>Provide primary and preventative health care exclusively for : </li></ul><ul><ul><li>Those who cannot afford private insurance and do not qualify for federal or state aid </li></ul></ul>
  • 5. Volunteers in Medicine (VIM) <ul><li>Accepts no federal or state funds, thrives through private philanthropy </li></ul><ul><li>Partners with secondary care centers (hospitals, offices) </li></ul><ul><ul><li>Provides diagnostic services and treatments </li></ul></ul><ul><ul><li>Given as charity care </li></ul></ul><ul><li>VIM is not a safety-net program </li></ul><ul><li>Prevention is key concept </li></ul>
  • 6. The Problem <ul><li>Estimate 45.7 million people without insurance </li></ul><ul><ul><li>over 12 million illegal immigrants </li></ul></ul><ul><li>May overwhelm clinics and absorb resources </li></ul><ul><li>VIM has strict eligibility requirements, but not on status </li></ul><ul><li>Decision can have financial, legal, and ethical ramifications and may threaten the public health </li></ul>
  • 7. Decision <ul><li>VIM should institute a national organizational policy change based on: </li></ul><ul><ul><li>Societal and marketplace demands </li></ul></ul><ul><ul><li>Financial risk involved </li></ul></ul><ul><ul><li>Threat to VIM mission </li></ul></ul><ul><ul><li>Risk to not being able to serve intended population </li></ul></ul><ul><li>Fragility of current U.S. health care system makes delay inadvisable </li></ul><ul><ul><li>Added eligibility requirements ensures VIM viability </li></ul></ul>
  • 8. Barriers <ul><li>Would face few barriers due to current legislation and public opinion </li></ul><ul><ul><li>Many already believe there should be limits in place </li></ul></ul><ul><li>Exception would be volunteers’ personal and ethical beliefs </li></ul><ul><ul><li>Staff discomfort could lead to decreased volunteer workforce </li></ul></ul><ul><ul><li>May be unable to turn those in need away </li></ul></ul><ul><ul><li>Staff could be turned into unwitting immigration watchdogs </li></ul></ul>
  • 9. Facilitators <ul><li>Projected cost-savings to VIM clinics and secondary care centers </li></ul><ul><li>Positive impact as clinics are decompressed and those qualifying for care receive proper resources </li></ul><ul><li>Provider motivation </li></ul><ul><li>Public opinion could be both barrier or facilitator </li></ul><ul><ul><li>Some communities may support restricting care; may be met with resistance in others </li></ul></ul>
  • 10. Implementation <ul><li>Establish a consensus </li></ul><ul><ul><li>VIM national officers and board of directors </li></ul></ul><ul><li>Transition team </li></ul><ul><ul><li>Present policy change </li></ul></ul><ul><ul><li>Reassure volunteer workforce </li></ul></ul><ul><li>Pilot programs </li></ul><ul><ul><li>For clinics serving large illegal populations </li></ul></ul><ul><ul><li>Use volunteer and patient feedback </li></ul></ul><ul><ul><li>Target goal: 12-18 months with future VIM clinics using revised policy </li></ul></ul><ul><li>Ongoing guideline development </li></ul>
  • 11. Evaluation <ul><li>Compare VIM clinics locally and nationally </li></ul><ul><ul><li>Patient numbers </li></ul></ul><ul><ul><li>Resource usage </li></ul></ul><ul><ul><li>Financial contributions </li></ul></ul><ul><ul><li>Public Health Department </li></ul></ul><ul><ul><li>Epidemiological statistics </li></ul></ul><ul><ul><li>Morbidity </li></ul></ul><ul><ul><li>Reviews/collaboration with secondary care partners </li></ul></ul><ul><ul><li>Affect to tertiary care departments </li></ul></ul><ul><ul><li>Financial impact </li></ul></ul>
  • 12. Future Considerations <ul><li>Interventional Care </li></ul><ul><ul><li>Internet-based treatment and telemedicine </li></ul></ul><ul><ul><li>Culturally specific, yet anonymous </li></ul></ul><ul><ul><li>Assumes access to cost-efficient technology </li></ul></ul><ul><ul><li>Upholds both civil and ethical obligations </li></ul></ul><ul><li>Use of immigrant specialists or nurse navigators </li></ul><ul><ul><li>Specifically trained in illegal immigrant issues </li></ul></ul><ul><ul><li>Assists patients in navigating the complex health care system </li></ul></ul><ul><ul><li>Serve as a resource for securing care </li></ul></ul>
  • 13. Future Considerations <ul><li>Mobile units for community outreach </li></ul><ul><li>Negotiated partnerships to offset costs </li></ul><ul><ul><li>Immigrant activist groups </li></ul></ul><ul><ul><li>Faith-based preventative or cultural centers </li></ul></ul><ul><ul><li>Worldwide charities </li></ul></ul><ul><ul><li>Foreign consulates </li></ul></ul><ul><li>Limited collaboration could: </li></ul><ul><ul><li>Coordinate compensation agreements for reimbursement </li></ul></ul><ul><ul><li>Exempt volunteer caregivers from ethical dilemma </li></ul></ul>
  • 14. <ul><li>“ Never doubt that a small group of thoughtful, committed citizens can change the world” </li></ul><ul><li>- Margaret Mead </li></ul>
  • 15. THANK YOU!
  • 16. References <ul><li>Copsey, H. (2008, October 8). Stuart clinic cuts free services for illegal immigrants, will require documentation. Florida’s Treasure Coast and Palm Beaches . Retrieved from http://www.tcpalm.com/news/2008/oct/04/clinic-cuts-free-services-for-illegal- </li></ul><ul><ul><ul><li>immigrants/ </li></ul></ul></ul><ul><li>Emergency Medical Treatment and Active Labor Act of 2003 (42 C.F.R. 489.24), amending the Consolidated Omnibus Budget Reconciliation Act of 1985 (42 U.S.C. 1395dd), section 1867 of the Social Security Act of 1935 (H.R.7260). 108 th Congress (2003). Retrieved February 4, 2009, from http://www.ssa.gov/OP_Home/ssact/title18/1867.htm#t </li></ul><ul><li>Free Clinic Federal Tort Claims Act (42 U.S.C. 233), amending section 194 of Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191), section 224 of the Public Health Service Act of 1944 (42 U.S.C. 201). 108 th Congress (2004). Retrieved February 11, 2009, from http://bphc.hrsa.gov/policy/pin0424.htm </li></ul><ul><li>Goldman, D. P., Smith, J.P., & Sood, N. (2005). Legal status and health insurance among immigrants. Health Affairs , 24 (6): 1640-53. </li></ul><ul><li>  </li></ul>
  • 17. References <ul><li>McKeon, E. (2006). Treating illegal immigrants: the ANA aims to protect nurses against potential criminal penalties. Retrieved February 5, 2009, from http://www.nursingworld.org/ajn/2006/jun/politics.pdf </li></ul><ul><li>Mead, M. (n.d.). The Institute for Intercultural Studies. Retrieved on February 18, 2009, from http://www.interculturalstudies.org/Mead/index.html </li></ul><ul><li>Morse, A., Blott, A., Speasmaker, L., & Dwyer, L. (2006, November 17). Immigrant policy- 2006 state legislation related to immigration. National Conference of State Legislatures Immigration Policy Project. Washington, D.C. Retrieved February 5, 2009, from http://www.ncsl.org/programs/immig/6ImmigEnactedLegis3.htm </li></ul><ul><li>Sherman, A., Greenstein, R., & Parrott, S. (2007). Poverty and share of Americans without health insurance were higher in 2007 and median income for working- age households was lower than at bottom of last recession. Center on Budget and Policy Priorities , Retrieved February 2, 2009, from </li></ul><ul><ul><li> http://www.cbpp.org/8-26-08pov.pdf </li></ul></ul><ul><li>Volunteers in Medicine. (2008). Volunteers in Medicine Institute. Retrieved Jan 31, 2009, from http://www.volunteersinmedicine.org/ </li></ul>
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