Canada: HIV Patients Check Out of Hospital Against Medical Advice to Collect Welfare
September 19, 2002
Medical staff personnel treating Vancouver's HIV/AIDS patients call the phenomenon "Welfare Wednesdays." HIV/AIDS in-patients at St. Paul's Hospital in Toronto frequently check themselves out, against medical advice, before their treatment is completed. The same patients often end up back in the hospital, in a worsened condition that requires a longer, more costly stay.
Authors of a new study on the phenomenon suggest provincial welfare rules are a key part of the problem. Welfare recipients who are in the hospital when welfare checks are cut do not receive their full monthly stipend. Monthly disability checks, which are regularly $825, can be reduced to $435 if the recipient is in the hospital, noted the study, published Tuesday in the Canadian Medical Association Journal (2002;167;6:633-637).
The authors studied records for all HIV/AIDS patients admitted to St. Paul's between April 1, 1997 and March 1, 1999, following each patient for a year from the time of his or her initial hospitalization. Of 981 patients, 125 (13 percent) checked themselves out against medical advice. The researchers found these patients were readmitted more frequently than patients who stayed until they were discharged by their doctors. They were also more likely to be readmitted with a relapse of their initial condition within 30 days, and they had significantly longer stays in their follow-up hospitalizations.
Welfare rules require recipients to appear in person to collect their checks. People on welfare can have their payments delivered to them if they are hospitalized, but most choose not to do so because that tips off the authorities of their whereabouts. Payments are reduced on a pro-rated basis if recipients spend a portion of the month in the hospital. The hospital has been looking at a program that would provide HIV patients on welfare with a financial incentive to stay in the hospital for their full course of treatment, said Pamela Miller, director of the HIV program at St. Paul's.
09.16.02; Helen Branswell
This article was provided by U.S. Centers for Disease Control and Prevention. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update. Visit the CDC's website to find out more about their activities, publications and services.