Have you or your family experienced difficulty paying medical bills? How can policy makers address this problem?

Transcription

1 Fifteen physicians, healthcare workers and community members met at St. Claire Regional Medical Center at 6:00 PM Monday December 29, 2008 to discuss healthcare. The questions discussed by the group are shown below with a summary of the discussion. Additionally, one of the physician participants (Dr. Ewell Scott) presented a survey (copy attached) which was completed by the participants. Dr. Scott had previously conducted the survey with physicians at the clinic where he is employed. The results of the survey are attached to this document as well. What do you perceive as the biggest problem in the health system? The biggest problem with the current health system is that it is broken. In past years, healthcare providers have been able to make enough money from the governmental and private payers (insurance companies) to cover the cost of treating those patients that could not or did not pay. This situation is changing as governmental payers (Medicare, Medicaid, etc) are lowering their payments to or below the providers cost. Private payers (insurance companies) are becoming experts at denying provider claims and/or are spending a significant amount of their money on advertising. At the same time payer reimbursement to providers is dwindling, there is an increase in the number of uninsured and underinsured patients due in part to the country s economic situation. The vicious cycle of uninsured and underinsured patients receiving health care at a cost to the insured patients is driving providers out of business. How do you choose a doctor of hospital? Where do you get information in making that decision? How should public policy promote quality health care providers? One participant, formerly living in another city, chose a provider close to her home from a Website. The experience was so traumatic that this patient did not return to a doctor for more than a year. Most patients tend to seek urgent care locally but choose a specialist or hospital because of the recommendation of their primary care provider. Healthcare systems tend to spend significant dollars to advertise but patients listen to their physician regarding specialty care. One solution in this area is to tie outcomes to the provider and allow patients to review the information. There was no significant discussion on the third question. Have you or your family experienced difficulty paying medical bills? How can policy makers address this problem? The group participants were not familiar with close family members not being able to pay their medical bills but knew of patients and others that encountered difficulties. There were a couple of stories of patients having to choose between having their prescriptions filled and paying other bills. In one case, the patient seemed to choose not to tell his physician that he could not afford the medication the patient s wife informed the physician. Statistics were mentioned that half the bankruptcies in this country are in some part because of healthcare payment pressures. The lack of ability to pay for health care takes its toll in other ways as patients can t afford living expenses or

2 lose other items through bankruptcy. The United States needs to look at other countries that have developed better health care systems. We seem to have a problem accepting that other countries have done something better than the US. In addition to employer-based coverage, would the group like the option to purchase a private plan through an insurance-exchange or a public plan like Medicare? The group took issue with the phrasing of this question inasmuch as it implies there has to be employer based coverage and the question leaves out the veterans plan. The idea of a private plan brings up thoughts of HealthSouth and its associated issues. Do you know how much you and/or your employer pays for health insurance? What should employer s role be in a reformed health care system? Most participants did not know the exact amount but realized the employer pays the majority of healthcare insurance costs. One physician indicated he pays $10,000 per year for insurance and, since the cost places a burden on him, it would be a greater burden for those with a lesser income. Discussion was held regarding the ability to pay for healthcare insurance. For example, a company CEO could pay more than a janitor making significantly lower wages. The group felt that a single payer system needs to be part of the debate and this question essentially eliminates that topic of discussion. Nobody disagreed that private healthcare should be eliminated. Some went on to say that employers should have no role in a reformed healthcare system. Are you familiar with the types of preventive services Americans should receive? Have you gotten the recommend prevention? If not, how can public policy help? Participants recognized that there are different types of preventive services that Americans could receive. However, there are geographical disparities throughout the country. Certain people live in areas that are more prone to cancer, smoking, and other such diseases. The question does not address these situations. There was discussion regarding public health departments past in increasing role in prevention programs. Also, the group recognized the need to refocus some of the planning, marketing and spending programs in the country. For example, one participant noted that more money is spent on marketing Altoids than the government spends on marketing good nutrition. Also, planners need to consider health when designing streets and roads to include walkways and bicycle trails. How can public policy promote healthier lifestyles? This question was not directly discussed. Instead the group used the last few minutes to discuss universal healthcare and implications. Some participants question the idea of building upon the current system as the current system is

3 broken. The idea of an entirely different healthcare system makes more sense. It could rely upon a financing system that is already in place (Internal Revenue Service) for a funding mechanism. A new system needs to have some form of accountability inasmuch as people that do not contribute have no incentive to stay healthy. From left to right: seated Lois Vice, Molly Carew, back row: Sonny Jones, Dr. Ed Scott, Steve Vice, Dr. Ewell Scott, Frank Olson, Dr. Fred Jalalon, Maura Carew, George Plage, Randy McCleese, Dr. Bob Doepke, and Tom Carew. Not pictured: Matt Watts (photographer) and Dr. Nancy Henly

4 This survey was completed by physicians at the clinic where Dr. Ewell Scott is employed and by participants in the Community Health Care Discussion. Results are shown below.

5 Ranking in order of highest value in a new health care system. Weighted value in parentheses. 1. System should have Universal Access (72) 2. System should highly stress disease prevention (41) 3. The system should be the highest National Concern (as opposed to local or state) (36) 4. Comprehensive services should be provided. Prevention, emergency services, trauma and care for ongoing illnesses, as well as dental,vision and mental health problems, and funding for home care when appropriate.(34) 5. More dollars should be spent for direct health care rather than administration of the system (25) 6. Strong support for patient choice (17) 7. The system should be able to control the rise in costs.(10) It should be noted that no person thought the role of government should be minimized. Also no participant wanted medicine to be treated like a business.