AZ Hospitals to Off-load Lost Monies to Patients and Insurance Cos

MsBruiser · Mar 22, 2009

I can't remember which section but there was an article in Sunday's Republic about how AZ hospitals will struggle in the forseeable future from reduced US and local government financial support. It stated AZ agencies (including AZ Hospital Assoc) expect the lost monies to be off-set by increased insurance premiums as well as anyone using hospital services.
And this happens just when you thought you were paying more than your share in healthcare costs. It's odd that everyone else has to make tough financial decisions and yet the hospitals spend like drunken sailors until they go belly-up. Insurance companies aren't without fault but I hope they put pressure on hospitals to be more financially responsible in this economic slow down.

I'm just a dumb staff nurse but here are my two cents:

The major source of revenue from hospitals are government sponsored (Medicaid/Medicare). Politicians of a certain persuasion are quick to denounce "socialized medicine" (they are idiots) but a huge percentage of this country's population rely on the government for healthcare. Unfortunately, hospitals cannot make much money off of government reimbursements. So more pressure is put on insurance companies and the pool of patients with private insurance. Yes, insurance companies are insanely greedy - but in a certain sense they are reacting to an economic reality. At the end of the day, someone has to pay for hospitals to keep the lights on.

Unfortunately, I look at the majoity of patients coming through my unit and most are medicare patients. They provide volume but little profit. Profits are not evil - for non-profit hospitals they pay for research, building expansions, etc. So the situation is grim.

At the end of the day, just as the US economy collapsed due to unsustainability (high debt, overheated real estate market, dumb investments) so will hospital systems. As the pool of privately-insured people shrink - and the number of uninsured/government insured rise - hospital systems will not be able to "keep up." Just as the financial system is getting a gigantic bailout, wait until hospitals start closing...

Jolie, BSN · Mar 22, 2009

I agree.

As I have posted on numerous threads pertaining to universal healthcare and healthcare funding, Medicare and Medicaid are notoriously poor in terms of reimbursement, often not covering the cost of care provided. And President Obama has proposed additional cuts in these programs. If not for self-pay and privately-insured patients who make up the difference, hospitals would quickly go under.

If we are forced into government mandated, taxpayer funded healthcare, there will be no one left onto whom to shift the un-paid cost of Medicare and Medicaid recipients' care.

In other words, when we all have government healthcare, no hospital or other provider will be able to afford to care for us.

MsBruiser · Mar 23, 2009

I'm glad you agree, Jolie, because our opinions are very, very far apart on the subject of universal healthcare!

Kabin · Mar 23, 2009

Before we provide healthcare for all we need to redefine what healthcare is so its sustainable. Maybe some of the more staggering statistics should drive healthcare changes.

- 75% of total healthcare costs are for caring for the chronically ill.

- 30 to 35% of Medicare dollars are spent in the last 2 years of life.

- Almost 33% of Medicare monies are unnecessary when treating the chronically ill.

- US demographics are frightening

MsBruiser · Mar 23, 2009

That is true. Also, include the cost of needless medical tests. My parents have excellent retiree health insurance that supplements medicare, and will do whatever useless scan their unscrupulous family md will prescribe (he happens to own all the imaging machines). Why? Because it doesn't cost them anything. My mother has even stated something to the effect of "I would never pay for this if I needed to use my own money". Perhaps a $1,000 deductible for imaging is a good place to start in order for people to consider "do I really need that test."

Jolie, BSN · Mar 24, 2009

Stopnik,

You and I need to sit down over a cuppa and fix healthcare. Because for 2 people with polar opposite viewpoints on the advisability of national plan, we agree on an awful lot.

As I understand it, you just suggested a deductible to encourage patients to weigh the necessity of an expensive test. That surprises me, because most universal healthcare proponents I've debated claim that deductibles will only continue to keep healthcare out of the financial reach of the poor, and thus are unacceptable. That is a huge source of frustration to me. Without personal responsibility for some portion (perhaps scaled to personal income) of healthcare expenses, there is no personal responsibility in utilization of services.

Those on Medicaid go to the ER with reckless abandon because they don't have to pay a dime to do so. I'm not talking about true emergencies where ER care is necessary and justified. I'm not even talking about high fevers on Saturday night when no clinic is open. I'm talking about people who show up there on Monday after school for a pregnancy test, a cough of 2 weeks' duration or back pain that started last Wednesday and doesn't interfere with anything.

If we were to give these patients HSAs with a predetermined a mount of money and required them to budget that money to meet co-pays, deductibles, part of precription expenses, etc., just like working Americans do, I bet we would see a decrease in unnecessary utilization of high-cost tests, treatments and ER visits, and an increase in clinic use, OTC meds and willingness to wait and watch with colds and other minor complaints. There would be incentive for the recipient to use that money wisely (because when it's gone, it's gone) and insist that their providers order care wisely.

Health insurance was originally intended to protect from catastrophic expenses. Americans were expected to save and budget for their routine and predictible healthcare costs. As another poster frequently laments, we have come to expect pre-paid healthcare at 100% coverage, and that's clearly not sustainable.

If we get insurance out of the business of paying for routine, predictible expenses, the cost for those services will once again become affordable, as we have seen with the advent of Quick-Care clinics in retail stores.

MsBruiser · Mar 24, 2009

Jolie - I think we are on the same page with regard to deductibles. So I guess that makes me the token proponent of universal healthcare that wants to see patients with some "skin in the game." That said, I'm too tired, old, and cranky to get any enjoyment out of debating policy - particularly Republican policies. I completely disagree with most everything you wrote beyond the second paragraph. It was a pleasure meeting you, though!