An alternative safety net to patient dumping

Hospitals adjusted their admitting practices and treatment protocols in response to the prospective payment system (PPS) enacted by the Health Care Financing Agency over a decade ago. Under PPS it is often not profitable for a hospital to admit and treat chronically ill individuals, with Medicare coverage, who may require extended periods of in‐patient care. It has been suggested in the literature that hospitals engage in “patient dumping”, or shifting high‐cost Medicare patients to public hospitals, to minimize loses. Institutional factors and market deficiencies result in discriminatory practices towards poor, elderly and disabled patients with limited or no health insurance coverage in the provision of health care. US Department of Veteran Affairs medical centers, however, provide an alternative, or safety net, for poor, elderly and disabled veterans who would be prime Medicare candidates for patient dumping.