In some healthcare facilities where patient charges are applied, they have introduced exemption mechanisms. Patients who can benefit from these exemptions receive exemption documents or may undergo assessments by healthcare workers to determine their ability to pay.
Despite global efforts to put an end to the practice of detaining patients in healthcare facilities due to unpaid bills, progress has been limited. These efforts have primarily focused on creating international human rights laws and national legislations, but they have not effectively halted the practice.
It appears that some healthcare workers are not informed about these laws and their legal responsibilities. They seem unaware that detaining patients in hospitals is illegal.
Detained patients often lack awareness of their rights, and even if they do, they encounter obstacles when trying to file complaints or seek legal remedies. These patients also have limited access to healthcare complaint mechanisms. Seeking legal redress can be financially burdensome and time-consuming.
In many regions, healthcare services have been decentralized and are under the jurisdiction of local governments. In such decentralized systems, policies and legislation established at the national level may not be easily implemented, especially when some healthcare services have been privatized. Cooperation among various government agencies is sometimes inadequate in decentralized systems.
The detention of patients is primarily observed in healthcare systems with inadequate health financing, commonly in low- and middle-income countries. In these nations, public funding for healthcare facilities is often insufficient or nonexistent. Even when central government funding is available, disbursements are often delayed, leading to a disconnect between funding and the needs of healthcare facilities. Health insurance schemes are not commonly in place to address healthcare financing challenges.
Many healthcare facilities in low- and middle-income countries rely on direct out-of-pocket payments as a source of revenue. These funds provide hospitals with some control over their operations and enable them to offer bonuses to healthcare workers. Consequently, healthcare workers may have a direct interest in increasing the collection of these payments.
Hospital detentions disproportionately affect vulnerable individuals who cannot afford healthcare or have health insurance. In some healthcare units with user charges, exemption mechanisms have been introduced. Patients eligible for these exemptions receive exemption documents or may undergo assessments by healthcare workers. However, these forms of exemption, based on direct targeting, often prove ineffective due to unclear eligibility criteria. Inadequate identification of beneficiaries can result in patients slipping through the safety net.
In many countries, there are no explicit laws prohibiting the detention of patients for financial reasons. When such laws exist, they should define the term “hospital detention for financial reasons” and specify under which circumstances it may be justified, such as for public health reasons like preventing the spread of contagious diseases.
These laws should be enforceable and provide remedies for detained patients, including court-ordered release or the release of deceased patients’ bodies. They should also include provisions for fines as a deterrent to the practice of hospital detention and should prohibit health facilities and healthcare workers from refusing to treat patients in medical emergencies due to financial grounds.
Despite ratifying international conventions and laws on human rights, many countries have not incorporated these laws into their national constitutions. It is essential to define, by law, the minimum health services citizens are entitled to, rather than leaving it in vague terms like “the right to health.”
Establishing domestic laws to formalize access to a package of essential health services aligns with the Sustainable Development Goals (SDGs), which emphasize the importance of the rule of law for development and equal access to justice. The SDGs advocate for non-discriminatory laws and policies, including those in the healthcare sector.
Contracts between health insurance providers and healthcare service providers can help reduce patient detentions due to unpaid bills. Healthcare facilities that risk losing their licenses are incentivized to minimize the illegal detention of patients, providing a means of accountability.
A law is only effective if it can be implemented and enforced, necessitating well-resourced institutions to monitor compliance and take action when needed. Impartial dispute resolution bodies and processes should be in place to help enforce patient rights. All stakeholders, including social workers and local authorities, must be aware of the legal framework surrounding hospital detentions.
Hospital Management Committees, local politicians, and Members of Parliament are essential stakeholders who should hold healthcare providers accountable and provide oversight while collaborating with each other.
