Hospitals in the United States are facing an ethical crisis in treating international patients who are unable to pay for their treatment, said Joanna Hedstrom, a Dartmouth MSc. student and former International Finance representative at Boston Children’s Hospital.
Hedstrom’s speech, which was attended by about 50 students in Rockefeller Hall, was sponsored by Michael Matly ’03 of the Bioethical Society of Cornell.
“I met Ms. Hedstrom during my summer research at Harvard Medical School, and felt [her talk] would bring together different parts of the Cornell community. We will all be patients one day,” Matly said.
Hedstrom’s duty at the hospital was to assess the finances of foreign families and coordinate their care.
“My role was to align the needs of the hospital and [those of the] patients,” she said.
The people that went through her office were foreigners classified as “self-pay,” who lack insurance and money to cover their services.
“The families are not so wealthy but just want the best care available for their child. This is their best and last course for a life-threatening condition. Parents will do just about anything for their child’s health care,” Hedstrom said.
Hedstrom gave several case studies of international patients who simply showed up on the hospital’s doorstep and demanded treatment. She detailed their various misfortunes and spoke of the astronomical cost of treatment.
“A craniotomy costs $60,000, cancer treatments range in the hundreds of thousands and transplants can cost upwards of $1 million.”
When a doctor presses for medical care, the hospital essentially has no choice but to oblige and potentially write off fees it will never see.
“It’s very hard to collect payment once a family has left the country,” Hedstrom noted. “Addresses are easy to falsify, people move and credit bureaus operate differently or are nonexistent in foreign countries.”
Hedstrom summarized the various loopholes that families use in order to receive treatment at no cost to them. For example, Massachusetts law states that hospitals must treat a patient admitted through an emergency room. Various provisions permit a child to receive insurance from the state if the family declares an intention to reside in Massachusetts.
Hedstrom concedes that families blatantly exploit this provision but added that hospitals have no way of reporting this behavior.
“[Hospitals] are not the health care police. I ask myself, ‘If I were the patients, would I do things differently? Would I be dishonest in order to save my child?'” Hedstrom said.
Anecdotes and rhetorical remarks aside, Hedstrom made little effort to answer the questions she brought up.
“Her comments were more of a logistical nature, while I was expecting more treatment on the ethical issues. She did address the important facts, though,” said Leti McNeill ’02.
Jaime Pardo ’02 offered a different response.
“She was quite informative in her presentation. I feel that everybody has a right to medical care, regardless of economic situation,” he said.
In the end, however, “someone has to pay for it,” Pardo concluded.
Archived article by Krishna Raghavan