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I looked more into the U.S. policy on uninsured patients, ER hospital policy, and how they are treated. If you go the ER without insurance, you are expected to pay the full bill; however you are guaranteed under the federal Emergency Medical Treatment and Labor Act to receive treatment regardless of your ability to pay it. There are assistance programs available to help those whom cannot afford to pay their medical bills. Some of these are private charities, there are government programs that help with those at or below the poverty line, and the hospitals themselves will often negotiate a much lower price than originally billed for to meet a patient’s financial need. Despite this, there are still many cases where all of the above are not sufficient enough to keep patients out of bankruptcy. (http://health.howstuffworks.com/medicine/go-to-er-without-insurance.htm)

The extensive citation show the work that went into the research to put the article together. The article cites other research articles as well as government publications and interviews.

Dr. Emily Goldmann graduated from the University of Michigan with her PhD in Epidemiology and Columbia University with a Bachelor’s in economics and Chinese. Dr. Goldmann is currently a clinical assistant Professor of Global Public Health at New York University. “I am currently on the faculty of NYU's College of Global Public Health, in the Division of Social Epidemiology. My current research focuses on the intersection between physical and mental health in older adults, specifically trajectories of depressive symptoms following stroke. I also have a strong interest in the characterization, prevention, and treatment of mental illness in low-resource settings globally. I currently teach a master's level course in global mental health and an introductory course in epidemiology to undergraduate students.” (LinkedIn profile)

Dr. Sandro Galea graduated from University of Toronto with his MD, Harvard with a MPH, and Columbia with a DPH. Dr. Galea works as a physician and epidemiologist at Boston University School of Public Health. “In his scholarship, Dr Galea is centrally interested in the social production of health of urban populations, with a focus on the causes of brain disorders, particularly common mood-anxiety disorders and substance abuse. He has long had a particular interest in the consequences of mass trauma and conflict worldwide, including as a result of the September 11 attacks, Hurricane Katrina, conflicts in sub-Saharan Africa, and the American wars in Iraq and Afghanistan. ” (Boston University Biography)

The bibliography is not included in the excerpt that we received. Based on the text it appears that many other research articles and outside studies were used as well as interviews.

The author uses a wide variety of news and journal sources to make their point. Everything from the New York Times to East Asian Science. It also cites many volumes on disaster preparedness. For example, “The Chernobyl Accident: a Case Study in International Law Regulation State Responsibility for Transboundary”. The sources tell me that the article was developed around the news at the time and works that dealt with handling of disasters from the past. For me, this furthers the case that the author is making: that the way we have been doing things in the past is not working.

I looked into how EMS operates in situations that are beyond protocols, standing orders, and medical control. I also looked into how story cases are used by other medical professionals. Further I looked into how “evidence” based approaches are formulated for studies and research.

1) “…what would happen if race and insurance status no longer determined who had access to the standard of care?

…in addition to removing some of the obvious economic barriers at the point of care, the clinicians and researchers considered paying for transportation costs and other incentives as well as addressing comorbid conditions ranging from drug addiction to mental illness. They also implemented improvements in community-based care, conceived to make AIDS care more convenient and socially acceptable for patients. The goal was to make sure that nothing within the medical system or the surrounding community prevented poor and otherwise marginalized patients from receiving the standard of care.

The results registered just a few years later were dramatic: racial, gender, injection-drug use, and socioeconomic disparities in outcomes largely disappeared within the study population [35].”

2)            “This model [PIH’s model], with conventional clinic-based (distal) services complemented by home-based (more proximal) care, is deemed by some to be the world's most effective way of removing structural barriers to quality care for AIDS and other chronic diseases.”

3)            “While some interventions are straightforward, we also have to recognize that there is an enormous flaw in the dominant model of medical care: as long as medical services are sold as commodities, they will remain available only to those who can purchase them.”