ACCORDING to the European intelligentsia, the U.S. is the land where the poor who can't afford health insurance die at the hospitals' doors because the are not admitted. This will come as a suprise:

ON Jan. 4, 2010, Raymond Fok was changing trains on his way to kidney dialysis treatment when he collapsed on the Canal Street subway platform. Emergency medical technicians examined him and took him by ambulance to the nearest hospital, New York Downtown, near the foot of the Brooklyn Bridge. Workers in the emergency room recorded that Mr. Fok’s speech was slurred and that he was lurching from side to side when he walked.

“He was a very typical hemorrhagic stroke,” said Jeffrey Menkes, the hospital’s president. From the emergency room, the hospital admitted Mr. Fok to the intensive-care unit on the third floor, where workers tried to find out more about their patient — not just his medical history, but his insurance or Medicaid status, his address, his Social Security or taxpayer identification number, the location of family members.

Once his condition had stabilized, the hospital moved him to a regular room on the fifth floor, where staff members expected to treat him for 7 to 10 days before discharging him to a sub-acute-care center for rehabilitation, the usual regimen for stroke victims.

Nineteen months later, Mr. Fok, 58, greeted a reporter from his bed in Room 516, eager to have a visitor. In the previous year and a half, perhaps 100 or more patients had come and gone from the room’s other bed, but Mr. Fok had gone nowhere. “Yes, I remember you,” he said. “John, right?”
The price of his treatment: $1.4 million.

And who was paying for it?

“The government,” Mr. Fok guessed, though he was not sure. “The hospital is losing money.”

In a city with a large immigrant population, it is not rare for hospitals to have one or more patients who, for reasons unrelated to their medical condition, do not seem to leave. At Downtown, where a bed costs the hospital more than $2,000 a day, there are currently three long-term patients who no longer need acute care but cannot be discharged because they have nowhere to go. The hospital pays nearly all costs for these patients’ treatment. One man left recently after a stay of more than five years.

They are the forgotten people in the health care system — uninsured, usually undocumented, without resources and stuck in the system’s most expensive course of care. Some are abandoned by or estranged from relatives; some belong in rehabilitation centers, where care is much cheaper, but because of their immigration status they are not enrolled in Medicaid or Medicare, so the places will not take them. For hospitals, some of these patients, like Mr. Fok, come in as medical cases and then quickly become puzzles for detective work.

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