The forgiveness of coinsurance: charity or cheating?

Article Abstract:

Forgiveness of coinsurance refers to the situation where a provider (physician or other health care provider) 'forgives' or waives the proportion of payment that would be made by an insured patient. The practice is fairly common and often occurs out of a physician's concern for the financial status of the patient, but forgiveness may occur for less scrupulous reasons. It can also add to escalating health care costs by encouraging overuse of services. Four types of situation involving forgiveness of copayment are discussed. In the most altruistic cases, the patient must receive such financial help, or forego treatment. Forgiveness benefits the patient, the physician (in terms of satisfaction), and the insurer, which could incur even more expense if the patient's condition worsens. The insurer could argue, however, that the doctor is discounting his services to the patient, but not to the insurer. Forgiveness may be used as a marketing tool to attract patients; the less expensive physician is often the more attractive. Two kinds of cases fall into this category: those where patients genuinely need treatment but would prefer to pay less; and those where medical problems (such as back pain) are exaggerated by providers to induce them to accept treatment. Services offered 'free', such as evaluations, may be promoted, then charged to the patient's insurance, with copayment forgiven. This leads to losses for both insurer and patient, whose premiums will ultimately rise. Forgiveness can lead to the patient's loss of 'consumer sovereignty'; the more he is insulated from the effects of higher bills, the less he is encouraged to look for lower-cost services. A case of fraud is discussed in which more than $200 million was falsely billed by a group of doctors who had told patients their copayment was not required. In fact, if the patients had known the large amounts being billed, they would probably have refused treatment. Overall, forgiveness of copayment is a positive act in service of altruism, but, when it is not, professional societies and physicians should take stands against the practice. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Economic aspects, Reports, Fraud, Health insurance, editorial, Cost shifting (Medical care), Coinsurance

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Abuse and neglect of elderly persons

Article Abstract:

Physicians caring for elderly patients may need to watch for signs of physical or verbal abuse and intervene when necessary. Definitions of elder abuse may vary, but all include acts of physical violence intended to hurt an elderly person. Psychological or emotional abuse may also be included in definitions of elder abuse, and may include threats, insults, or statements that humiliate or treat the elderly person like a child. Elder abuse may include acts of material exploitation or misappropriation of money or property. Neglect on the part of a designated caregiver to take care of a dependent elderly person may be considered abusive. Physicians may contact their state's ombudsman, as provided for in the Older Americans Act of 1976, to report suspicions of abuse. Adult Protective Service agencies in each state may conduct home investigations and interviews of caregivers. Doctors of elderly persons should know how to interview them to find out if an abusive situation exists, and should offer counseling or alternative living situations to prevent the abuse. Spouses and adult children may be the most common abusers.

Care and treatment, Aged, Elder abuse, Abused aged, Abused elderly

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Should patients with Alzheimer's disease be told their diagnosis?

Article Abstract:

Physicians and family members often disagree regarding whether patients in the early stages of Alzheimer's disease should be told their diagnosis. Often family members request that patients with Alzheimer's disease not be told their diagnosis. Diagnosis of Alzheimer's disease is based on neuropsychological tests, and cannot be confirmed for certain until after death. The prognosis for patients with Alzheimer's disease is uncertain, and treatments are limited. Many physicians believe that patients should be told their diagnosis. Individuals who are informed of their diagnosis can make decisions regarding their medical care, and do other types of planning while still competent. Many patients change their minds regarding treatment after their disease has progressed, but Alzheimer's disease patients do not have this option. As their disease progresses, they lose the capacity to make informed decisions, and their care takers must rely on earlier instructions.

Ethical aspects, Alzheimer's disease

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