NCPA - National Center for Policy Analysis

Permanent Patients

January 6, 2012

Medicaid often pays for emergency care for illegal immigrants, which allows them to be treated in hospitals at no cost to the individual.  However, because this reimbursement does not apply toward continuing care, and because hospitals cannot discharge patients into shelters or the streets, many hospitals face the quandary of what to do with patients well enough to leave.  Many such patients have nowhere to go and no family to take them; meanwhile other health facilities have no incentive to accept patients who cannot pay.  This leads to the problem of "permanent patients" -- healthy patients who spend years in hospitals after treatment has been concluded because they have no other options, says the New York Times.

  • New York City, a jurisdiction that has a particular problem with permanent patients, is estimated to have 300 of them throughout the city.
  • New York Downtown, a private health institution in Manhattan, spends about $2 million annually on such patients out of a total operating budget of about $200 million.
  • Care for a patient languishing in a hospital can cost more than $100,000 a year, while care in a nursing home can cost $20,000 or less.

These patients, who have been caught between a bureaucratic nightmare and an ill-conceived Medicaid scheme, cost the hospitals where they take up residence millions of dollars per year.  Additionally, as is evidenced by the price differential between hospital care and nursing home care, much of this post-treatment care can be more efficiently given (and with better outcomes) elsewhere.  However, the Medicaid reimbursement system discourages (to the point of prohibiting) the transfer of patients necessary to take advantage of these lowered costs.

An additional problem in this regard is that hospitals are a dangerous place to remain in the long term, as the risk of infection is significant.  This makes it possible for patients who are brought in with a mild problem to develop something much worse over the course of their stay.  Thus, for patients who stay for a longer period, the risks are even higher.

Finally, the phenomenon of "pop drop" has also developed in recent years.  This is the method by which the grown children of illegal immigrants leave their parents at a local hospital and then leave for vacation.  In this way, the parents receive free medical care and a place to stay while their children are out of town.

Source: Sam Roberts, "Nowhere to Go, Patients Linger in Hospitals, at a High Cost," New York Times, January 2, 2012.

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