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Faithful flocking to another option for healthcare costs

Some of my patients belong to a healthcare-sharing ministry instead of having traditional health insurance. What are the pros and cons of belonging to such an organization?-S.C., KAN.

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These organizations are similar to insurance in some respects, but they don't provide the same level of benefits and protection. These faith-based nonprofit organizations pool monthly payments from members, which are then used to pay for certain medical costs of members each month. Because healthcare-sharing ministries aren't health insurance, consumers aren't protected under their state's insurance laws or consumer protection acts. For instance, coverage isn't guaranteed and the consumer may not have any recourse if a service or illness isn't covered. Fewer statutory-based consumer protections would be available to the participant and subscriber in cases alleging fraud, malfeasance, or other wrongs. Unlike the case with insurance coverage purchased under the Affordable Care Act (ACA), preexisting conditions can be excluded from coverage or the patient may have to pay extra for them. Certain conditions aren't covered, such as those caused by alcohol, smoking, or illicit drugs. Some services and medications, including preventive services, mental healthcare, and contraceptives, may not be covered. Many ministries don't cover the cost of maintenance medications, and they generally require members to pay for their "annual personal responsibility," similar to a deductible, before medical expenses are reimbursed.1,2


So what are the benefits? Some members enjoy expressing their faith by sharing their resources with others who share similar values and beliefs. Belonging to such an organization, as long as it's been in existence since 1999, fulfills the individual mandate of the ACA to purchase healthcare insurance. It's also substantially less expensive than unsubsidized healthcare insurance purchased through the ACA marketplace. Members can usually use almost any provider they like. The ministry negotiates a price for services with the providers and typically pays them in cash. Another benefit is that providers don't need to get insurers' permission to make treatment decisions.1


Some ministries require that members belong to an evangelical Christian faith, but at least one is more open to people of other faiths and same-gender couples.3 Most ministries have limits for the costs of medical incidents, but these limits are higher if catastrophic coverage is purchased.1,2 Those considering this type of ministry need to thoroughly investigate the organization and be prepared to assume some risks.



1. Zamosky L. Healthcare-sharing ministries: a leap of faith? 2016. https:// [Context Link]


2. Healthcare Sharing Group Comparison. [Context Link]


3. Berlau M. How Matt Drudge (and other Obamacare victims) can escape the "Liberty Tax." 2014. [Context Link]



Patient secretly self-medicates in the hospital

I recently learned that a patient in one of our med-surg units took her own oral antihypertensive medications while she was hospitalized without telling anyone. She didn't understand that she was receiving I.V. antihypertensive agents, but fortunately the situation was quickly discovered and she wasn't harmed. How could this situation have been prevented?-F.S., ARIZ.


According to the Pennsylvania Patient Safety Advisory, some patients continue to take their own medications in the hospital due to some level of misunderstanding. For instance, they may not know that they shouldn't take their own medications in the hospital, their medications have been temporarily discontinued, or they're receiving them via a different route in the hospital. Some may want to gain a sense of control. If patients bring their medications to the hospital for medication reconciliation, explain why they were needed and then encourage family members to take them home.


This case highlights the importance of patient teaching. The medication error might have been avoided if the patient's nurses had explained what drugs she was receiving and their purpose.



Grissinger M. Patients taking their own medications while in the hospital. Pennsylvania Patient Safety Advisory. 2012;9(2):50-55.



Keeping up with licenses and training

I retired as an RN over 2 years ago and am still holding a license even though I have no plans to go back into nursing. Through oversight, I let my basic life support (BLS) training lapse and am wondering whether I should retake the course. Is it a legal imperative to have BLS training as an RN? The other, deeper question: How long should I continue to renew my RN licensure? Are there any legal ramifications to continuing to hold a license when one isn't practicing?-J.W., MICH.


The license to practice professional nursing is a prerequisite to practice in all 50 states. The license is evidence of basic competence to practice, which is usually determined by examination at the initial stage of licensure. When you retire from the practice of nursing, maintaining a license is no longer necessary unless you believe you'll reenter practice at some point.


Remember also that successfully completing BLS, advanced cardiovascular life support (ACLS), pediatric advanced life support (PALS), or similar training does nothing more than provide evidence of one's motor skill and subject matter competence in a nationally standardized program. It isn't evidence of a specialty or subspecialty ability. If you're retired from nursing, you're not required to complete BLS, ACLS, or PALS training unless you wish to keep your skills current.


Should you continue to hold a license after retirement? You may do so, but remember, if you take any professional actions or render nursing care, even in an emergency, you'll be held to the same legal standard as any licensed professional nurse.