Children are chasing one another around the blue chairs. An old man hunches over and vomits into the garbage. A baby cries hysterically in her mother's arms. This is the emergency room at the University Hospital in Newark, New Jersey.
It's an early evening in spring. There haven't been any disasters in the neighborhood, nor is there an outbreak of disease. Rather, this is the outcome of a poverty-stricken city. Many citizens of Newark who are unemployed and uninsured cannot afford an office visit with a doctor. So they go to the emergency room, where the poor and under-insured among them receive care for free or at a reduced rate under the New Jersey Hospital Care Payment Assistance Program. Many patients call it "charity care."
Under the program, the New Jersey Department of Health and Senior Services requires 80 of its member hospitals to treat any patient in need of health care regardless of his or her ability to pay, explains Tom Calandra, a research scientist at New Jersey's Department of Health and Senior Services. The program, he said, is active in six of Newark's hospitals.
According to the New Jersey State Health Care website (www.state.nj.us/health) in 2002, University Hospital received close to $85 million for charity care subsidies. University Hospital receives the most money of the participating New Jersey hospitals.
Calandra said the program covers or reduces any costs incurred by either an emergency room visit or any medical situation that calls for a doctor. The program pays for hospital costs but does not cover routine office visits, physicians' bills or prescriptions.
According to eligibility standards, an unmarried patient who makes less then $10,000 annually and who has few assets is a good candidate for charity care. Underinsured individuals are also eligible for some benefits under the program. If a patient isn't aware of the service at the time of the visit, he or she has one year from the date of the visit to apply for charity care retroactively.
At the University Hospital emergency room, the emergency units bring in critically injured patients and set them down next to the others with less urgent conditions. The room is crowded and loud. Its smell is unpleasant.
Many patients, some having waited for more than three hours, go to sleep. Others go shopping across the street at Pathmark while family members anxiously hold their place in line. One frustrated patient begins to argue with a nurse and an uproar follows.
Maria Smith, a 45-year-old resident of Newark, praises the program and says it alleviates many of her concerns. She says that if any of her family members are ill, "I don't have to worry about paying bills I can't afford." She also says that as frustrating as it is to wait, "it's worth it." She says, "I know that I can't afford this on my own and the hospital helps me, so I am willing to wait and take my turn."
Janet McMillan, sitting next to her, snaps at Smith's comment. "What kind of service is this when you have to wait for an hour?" McMillan, recently laid off, says she can't wait to find a job with health insurance. "I hate having to wait to be seen by a damn doctor."
A nurse, who wouldn't disclose her name, says: "We try to make everyone's stay pleasant. We know it's hard but we are short staffed." She adds: "Many aren't here because of an emergency per se, but we care for them, and they should understand from our perspective that it is hard to juggle so many people at once."
Many of the patients, she says, qualify for charity care. And although it adds to traffic in the emergency room, she feels it's a "wonderful program" and has great potential in a city like Newark.
Tamara Odisho, Rutgers-Newark '02, majored in journalism and media studies.
