Health Reform Should Include Legal Care for Patients

If the country is serious about reforming the healthcare system, then it needs to look beyond just improving access to medical care.  Reforms must acknowledge and address the underlying causes of poor health, many of which cannot be adequately treated by healthcare professionals alone.  Indeed, for some 50 million low-income Americans, the barriers to getting healthy represent unmet legal needs better remedied by a lawyer than a healthcare professional.

Unenforced sanitary codes leave families living in unsafe housing where children are made sick by mold, or made sicker by the fact that utilities in their homes have been wrongly shut off.  Health system complexities and inefficiencies prevent seniors from benefitting from the insurance and long-term care coverage to which they are entitled, and keep wounded veterans from accessing durable medical equipment such as a wheelchair or other crucial supports.  In each of these cases, traditional healthcare services – no matter how expertly administered, and no matter how capable and compassionate the clinician – will not improve individuals’ health.  Rather, legal assistance is crucial to negotiate with landlords and utility companies, appeal denied insurance claims and expedite access to veteran benefits and services.

Recognizing the negative impact that unmet legal needs have on individual and population health, and addressing them as a critical part of comprehensive healthcare, should translate into a healthier and more productive populace, and a more efficient healthcare system.  The way to begin is to build strong partnerships between the healthcare and legal communities.

The legal aid community has long been in the business of improving the lives of the most vulnerable members of society, facilitating access to housing, insurance and utility service.  Their efforts are reinforced by the remarkable volunteer ethic in the legal profession that leads lawyers to donate millions of hours of free legal assistance annually.  But this work is done almost completely separate from healthcare professionals.  This is so even though key portions of their client populations overlap.  The need for a coordinated approach is more urgent than ever.

Across the country, innovators in healthcare and other fields are developing new models of healthcare service delivery that more comprehensively address the root causes of poor health and eradicate barriers to effective treatment in ways that are cost-effective.  All stakeholders – patients, providers, payers, policymakers, and others – in a healthcare system built on equity and comprehensive care  must examine  these innovative models to determine how best to re-allocate national, regional, and community resources.

Medical-legal partnership (MLP) offers one such model.  More than 275 hospitals and health centers across the United States have partnered with existing local legal services agencies to integrate attorneys into their healthcare teams to help children, the elderly, veterans and patients with complex and chronic illnesses.  These lawyers provide direct legal assistance to patients and work alongside doctors, nurses and social workers to improve institutional and systemic policies that impact the health of patients.  On April 11 and 12, leaders from law, healthcare, public health and government will gather to discuss how better to integrate health and legal care for vulnerable people at a Summit hosted by the George Washington University School of Public Health and Health Services’ National Center for Medical-Legal Partnership.

A doctor would not send a patient home with acute appendicitis knowing that the appendix could rupture at any moment.  Nor should any physician be forced to send a patient home knowing that her unsafe housing will force her back to the hospital time and time again, especially when the requisite expertise exists to treat the underlying cause of the patient’s illness.  The nation needs and deserves a healthcare system that prioritizes unmet legal needs alongside traditional healthcare, and we would like to see the MLP model scaled so that every low-income individual has access to legal resources as a standard part of their healthcare.  By leveraging the expertise and resources of the healthcare and legal professions, MLPs stand ready to play an important role in a modernized, more efficient, more effective healthcare system.

The 2013  Medical-Legal Partnership Summit is taking place on April 11-12 in Bethesda, MD.

Joel Teitelbaum, J.D., LL.M., is Associate Professor in the Department of Health Policy at the George Washington University School of Public Health and Health Services, and co-Principal Investigator of its National Center for Medical-Legal Partnership.

Tom Koutsoumpas is Senior Vice President of ML Strategies and Executive Director of the MintzLevin Center for Health Law & Policy.

6 replies »

  1. That’s good to hear. Although our legal system has an adversarial component that is (I think) important for protecting people’s rights, ways to incorporate collaborative approaches will (I think) reduce some of the costs that are the unintended consequence of our current paradigm. I do wonder, however, how conflicts of interest are handled that protect patients and provider organizations, and if lawyers are being trained differently to handle disputes in a non-adversarial way. I think that would be important – I think that may also be happening in family law as well as they have found that non-adversarial approaches leave less adverse effects on all parties, including children.

  2. platon20: These partnerships are actually leveraging existing resources and the legal aid community is providing half the funding. Preliminary data shows that incorporating legal care into healthcare services actually saves healthcare institutions money because problems are detected further upstream, and legal problems that can cause costly health crises are prevented. And yes, there is also significant attorney time being donated pro bono as well.

  3. We agree Sandra_Raup. MLPs address a range of social determinants of health and promote efficiencies within the healthcare system. One of the great things about these programs is that lawyers are working as part of the healthcare team and with their partners in a problem-solving, not adversarial mode.

  4. Lets get real here — this is a power grab by unemployed lawyers who want to bill Medicare for services because they cant make any money in their own field.

    I’ve got no problem with lawyers assisting inside of clinics with tehse issues, but this is about $$$, just like it always is. Lawyers like the guy who wrote this piece want the authority to bill Medicare so they can make money off of the healthcare system.

    Doctors only take 10% of total heatlhcare costs — the last thing we need is more bureaucrats taking a piece of the pie. If lawyers want to work on these issues pro bono, thats fine.

  5. Joel, I also think lawyers acting as patient advocates but employed by healthcare organizations would help as well. So often medical care gets “defensive” becausea there aren’t good ways to address problems and help patients understand what’s going on. Rather than taking on an adversarial mode, patients and providers could have a problem-solving mode that would help everyone involved. I think I’ve read about some demonstration projects – is the Summit addressing that type of partnership as well?

  6. Generally applaud this piece. But medicine and health care doesn’t need more lawyers. We DO need Federal health agencies with teeth that go beyond useless and ineffective hand- slapping.

    We also need more engineers who can fix our public health infrastructure

    Dr. Rick Lippin