The health care conundrum: Providing access to the uninsured while balancing costs
Wisconsin Medical Journal, Vol. 104, No. 8, 2005
By Christy Mokrohisky, MBA and Donald C. Logan, MD
Who deserves access to health care? If we agree everyone deserves medical care, who bears the responsibility of paying for care for the uninsured and underinsured?
In this article, we will address the financial impact that the uninsured have on the health care delivery system and outline the efforts of Dean Health System to offer quality care to the uninsured through innovative programs and community partnerships.
Delivery health care is a balancing act of providing access to quality care and managing costs. Today, the debate primarily relates to cost concerns. Health care professionals feel boxed in by lower reimbursement rates. Employers, facing rising health care costs for their employees, are making tough decisions about their ability to offer their employees affordable health insurance. Yet it may be the patient, paying more out-of-pocket expenses than ever before, who feels the sharpest sting of rising health care costs.
And the costs show no signs of slowing, especially given the growing number of uninsured and underinsured in America. Access to affordable health care is an issue that hits home to our nation's 45 million uninsured (see sidebar). The number is staggering to most of us in the health care industry.
Even more daunting than the number of uninsured is the way in which they access health care. The uninsured often use emergency departments as their primary care homes. They need more sophisticated and expensive care because they postpone diagnosis, delay needed tests, and often don't have enough money to fill their prescription medications, according to the Center for Studying Health System Change.
As a nation, we need to identify the consequences of caring for a population that does not have access to preventative health care. As physicians and administrators, our challenge is not simply providing access to care for the uninsured, it is providing more efficient and cost-effective care.
Who Bears Financial Responsibility?
Health care professionals are being asked to bear a substantial financial responsibility for patients who do not have the ability to pay their medical bills. Uninsured patients and those on government programs with low reimbursement rates for services, such as Medicaid, cost health care systems more than they can recover.
Cost shifting occurs when one group of patients pays less than the true cost of their medical care. In order to recover the costs of patients who can't pay, provider systems increase prices for those who can. The result of cost shifting: everyone with health insurance ends up paying more for care.
In the case of the uninsured, the cost of care is transferred to patients with health insurance. Insurance companies manage inflated prices by imparting a great financial load to their members in the form of higher premiums, deductibles, and co-pays. Consequently, higher costs for both the seriously ill and low-income workers create a financial burden they are often unable to absorb, forcing many to enter into the pool of uninsured Americans.
The private and public sectors endlessly debate who is more equipped to manage patient care and curb cost shifting. Discussions of universal coverage and consumer-driven plans are at the heart of those debates. Are additional government programs needed to care for the uninsured or is Medicaid adding to the problem of cost shifting? What is the role of the health care professional community in addressing issues of the uninsured?
Physicians and administrators at Dean Health System engaged in discussions on these topics 12 years ago and established what is known today as Dean's Community Advocacy & Partnerships Department.
This department manages uninsured and other vulnerable patients by teaming up with community organizations and delivering programs tailored to the individual needs of our patients. The programs have won local and national awards for innovative solutions to advance health care delivery and improve community well-being.
Here is an overview of some of Dean's programs:
Health care professionals will continue to feel the impact of the uninsured on our individual patients and our businesses. Although concerns of access, cost, and quality related to the uninsured are too big for any health care system to tackle on its own, there is a role for health care professionals in managing patients in our communities who lack health insurance.
One Third of Americans are Estimated to Be Uninsured or Underinsured
Unless otherwise noted, data is from the Kaiser Family Foundation.