In most medical centers, decisions about who gets scarce resources such as expensive drugs and surgical procedures are often made on an ad hoc basis with few formal guidelines for doctors and nurses on how to help their patients while keeping within the budget. But at the oldest public hospital and medical school in Texas, officials have decided to spell out a set of rules and regulations and call it what it is: rationing.
When Phyllis Kinsey-Scothorn had a heart attack, she was rushed to the University of Texas Medical Branch in Galveston, a public hospital.
“They took care of me. They saved my life,” said Kinsey-Scothorn, who had a job but no health insurance.
However, when she went back to the hospital for needed follow-up care, the hospital said she couldn’t get it until she paid her bill for the first treatment. “It’s very degrading,” Kinsey-Scothorn said.
Kinsey-Scothorn had come face to face with new policies at the hospital that call for strict limits on care for those without the means to pay.
Infinite needs, finite resources
For more than a century, since the state of Texas first opened the hospital in 1891, the institution's policy had been that no patient gets turned away. But in recent years, officials have decided that policy is simply no longer possible and instead have turned to a system of medical rationing.
“I’m willing to call it rationing because that’s what it is," said Dr. Joan Richardson, the hospital’s medical director. With one third of Texans lacking health insurance Richardson sees rationing as a necessary evil.
But, she says, “It makes me angry. That’s not what I signed on to do.”
Under the new policy, undocumented immigrants get nothing but emergency care. Others without insurance get only what the hospital deems to be basic necessities. Many procedures and medications are simply prohibited. The only exceptions are cases that offer unique opportunities for learning among medical students and residents.
“I now know, and I think a lot of us now know, that our resources are finite. But ... the needs really seem to be infinite,” Richardson added.
Kinsey-Scothorn eventually qualified for Medicaid and now receives regular medical treatment. But many see the rationing at this public hospital as the future of American medicine for those who cannot pay.