Illness, trauma, and high risk don’t notice whether a person has health insurance. Catastrophic illness has become the most common cause of bankruptcy. In the old days, patients with good insurance helped make up the difference for those with little or no insurance. But those days are gone. In the present environment, the number of uninsured and underinsured Georgians continues to climb, even among those who work one or more jobs. As the cost (and curative power) of new treatments increase, the amount that payers are willing to reimburse health care providers continues to decline.
     In a time like this, what do Emory’s doctors, hospitals, and clinics do?
     What they have always done: provide the best care possible to the patients who need it. That means in 2004, the last year for which complete figures are available, counting patients from every county in Georgia, Emory Healthcare physicians provided $51.7 million in charity care, a number that appears likely to continue to rise (see table on left).

By the time the young, South Georgia woman arrived in Emory University Hospital’s emergency room, her liver was failing because of unexpected reactions to a prescription drug. The week before, she had been perfectly healthy. Now, she would die unless a new liver could be transplanted within 48 hours. Having listed her as Status One—highest priority—on the liver registry, Emory Healthcare clinicians focused on getting her ready if an appropriate donor match could be found. There was no time to worry whether she had insurance. They were going to save her life whether Emory got paid or not. They did save her life, and only the business office ever knew if the institution received any money for it.
     Emory’s policy regarding patients who will die without a liver, heart, or lung transplant is to operate without regard to financial status. That’s a big gamble. The average cost of liver transplantation is $150,000, although complex cases can easily top $1 million. With one of the Southeast’s largest liver transplant programs, Emory Healthcare provided $7.95 million in direct charitable care for liver, heart, lung, and other transplant patients between September 2001 and April 2005.

The patient had been referred to Emory Healthcare because he needed specialized surgery unavailable in many hospitals in the state and because he had a medical history that would alarm any surgeon—or hospital administrator. Sometimes inexplicably, the patient’s blood failed to clot normally, and he experienced hemorrhage. Sure enough, at Emory this patient’s surgery went perfectly, but he continued to bleed. And bleed. And bleed. None of the usual medications could make it stop. The surgeon called for the first dose, then the second, then the third of factor VII, a synthetic blood-clotting agent. The drug is used widely for people with hemophilia, but many insurers refuse to cover its use for any other clotting problem. This man did not have hemophilia. Knowing that two other patients had needed the same medication within the past quarter, chalking up large unreimbursed expenses for the hospital, the surgeon called the hospital administrator with a heads-up. It wasn’t a question of permission, since both knew this was the only way to keep the patient alive, whether the insurance company agreed or not. It took more than 20 doses—at $10,000 a shot—before the patient’s own body took over the work of clotting and he was able to go home.

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