Insuring the uninsured

 

By Michael A. Anaya, Sr., FACHE

 

If ever the time were right to focus, research, collaborate, and put in practice a process toward insuring the uninsured, that time would definitely be now. This serious problem has plagued our nation for years and has escalated within the past decade. It is a topic that is clearly defined in our nation's broken healthcare system, the political equivalent of “Remember the Alamo ” come election time or legislative session. It is an enduring, pervasive dilemma that receives more media ink than any other healthcare issue.

How can a group of mostly nonpaying individuals better the economic cycle of a hospital, or the community that a health system serves? It usually is not very favorable, as we know we are already taking care of this group increasingly every day through our emergency rooms. As a result, when thinking of the uninsured, you envision a nonpaying, fast-rising, debt-loading population that has been discussed for decades but has not been addressed.

How do we increase the number of insured, while at the same time decrease the number of uninsured? One might say that the message these two phrases send are very different, and the potential interest in working with that group varies. The first statement merely conveys a diminishment of a serious financial drain, while the other represents the potential for increasing expanding services, better serving the needs of the community, and market share. How can we address this with the numbers of uninsured rising to over 44 million at the national level? My belief is that this can be addressed at the local level and that we need to alter our way of thinking to fire our imagination.

Many, even those within our own industry, do not realize we are in a vicious cycle of consequences that have debilitating ramifications for everyone. Much of the reason for this is the nature of healthcare in the United States , which unlike any service or good in the nation, is viewed as an entitlement. A sentiment that was perceptually adopted and legally supported was made in 1946 by President Harry Truman, who stated, “Healthcare should be a right, not a privilege.” And healthcare providers in this country are legally obligated to treat anyone who seeks care, regardless of the patient's ability to pay. The outgrowth of this right is that the costs for those who cannot pay are borne by those who can, meaning the healthy and insured are supporting the unhealthy and the uninsured. This intensifying problem of fewer insured is leading to increased ER visits. This results in substantial inefficiencies in the healthcare system. An ER visit is far more costly to the overall system than the cost of a visit in a physician's office or an urgent care center. An estimated 50 percent of those treated in the ER could have been treated in a less acute and far less costly setting. This example of inefficiency in the ER is only one example of how larger numbers of uninsured lead to higher overall healthcare costs. Who pays? Ultimately everyone, but the first line of payment is borne by the larger corporations, the group that picks up the tab for the major share of commercial healthcare in the United States . You might ask, “Why haven't large corporations taken a more active role in shaping healthcare policy?” The problem historically has been the healthcare providers' responsibility, as employers have not linked the connection between the rising number of uninsured and the steadily increasing premiums. Again, my point is the healthy and insured paying for the unhealthy and uninsured; a clear case must be made for a community solution.

I believe that the steps to decreasing the number of uninsured are as follows:

• Enlist and engage the employers in discussion and resolution;

• Establish a purchasing cooperative;

• Develop a retail-type model using vouchers;

• Involve a wide spectrum of community-based individuals and enterprises;

• Assess the current situation, tailoring to needs of the community;

• Outline solutions, select and execute;

• Evaluate incremental results, modifying as appropriate.

There are three reasons to undertake this initiative. First, it's the right thing to do. Second, I want to send a message to the community we serve, that healthcare providers are about more than just money. Third, if the problem is not addressed soon, the financial fallout will be severe. The rapidly rising number of uninsured will likely capsize many hospitals and health systems. One of my many goals is to work mutually toward this goal of doing more to help those in need and in enhancing healthcare delivery to this community.

 

( Michael A. Anaya, Sr., is the chief executive officer of Doctors Hospital of Laredo .)