After reading about many of the national Health Care Reform proposals being discussed, it seems the one thing that everyone agrees on is that our system is broken. My top three suggestions for areas to focus on are:
1. A single payment system. I believe one of the most efficient providers of care is Medicare, through which roughly 3% of the health premium dollars go toward administrative costs and the rest is allocated to direct care expenses. Compare that with monetary allocation process used by a majority of insurance providers, through which about 30% of healthcare dollars are used toward administrative/marketing costs and the complicated expense payment system. The Medicare system provides price transparency for consumers; trying to get the same information from your insurer, hospital or doctor on non-Medicare coverage and is nearly impossible. Potential savings: 27% of 1.1 trillion dollars. A good start.
There are several not-for-profit insurance models that operate on a breakeven philosophy, such as Aultcare in Canton, Ohio. This means that out of every healthcare premium dollar collected –except for administrative expenses—those monies, go toward the actual care provided. This translates into more money for the providers of care and lower costs to the healthcare consumers.
2. Hospitals and doctors focus on quality and service transparency. Assuming a single payment system, prices would clearly be defined. Insurers, whether governmental or private payers, would earn their customers through service, value and performance.
While we are working on #1(single payment system), all providers, doctors and insurers should be required to post their actual rates and payments. Under the present system, consumers who are paying about 13% of out-of-pocket expenses receive much better information through a car purchase than they do regarding their own health care. Quality and service indicators are easily understood and actual dealer costs and mark-ups are available on such website as consumer reports.com. Many insurance provider contracts prohibit the sharing of this information. But, consider this: Who shops for cars at list price? Currently these are the prices you see from providers on our healthcare websites -- list prices. Right now, there are only a few hospital systems that are advocating for publication of healthcare services provided.
3. Consumer accountability. The bottom line is, consumers need to be more directly involved with the purchasing of their own care and the financial consequences related to their actions. Consumers who don’t actively work on preventative health measures should be paying more of premium dollars for their coverage. Smokers should pay more than non smokers. Individuals who are proactive about managing chronic conditions should pay less of a premium than those who don’t. Hospital and other employers should continue to redefine our benefit package to encourage this.
Now that I have been able to vent, let me move on to some concerns I have as a local hospital administrator. Our not-for-profit status is being questioned by many: do we deserve it? Let me begin by stating the obvious, we do get a tax break of about $2 million dollars a year. As expensive as it may seem, there are several critical services that community hospitals provide that still don’t cover their expenses and lose a lot of money. At our hospital, maintaining our Emergency Department through physician coverage loses about $500,000 a year, while our OB department, on average, loses close to another $1 million a year.
Overall, how do we? As a not-for-profit we still need to make money to remain viable, but instead of sharing those profits with shareholders, we use them to pay for services that are not justified on a financial basis. Below is a copy of our Community benefit report for 2005 and 2006, which includes a summary for Ohio hospitals.
-- Stan
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