Absorbing the Cost

By Dan Gorenstein on Tuesday, March 11, 2003.

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In health care circles, people talk more and more about something called cost shifting.

Cost shifting happens every time a doctor treats a patient who has no insurance.

Some of those costs, get passed along to insurance companies, businesses, and other patients.

Yesterday in Manchester NHPR’s Exchange held a town hall meeting on the uninsured, and cost shifting was central to the conversation.

NHPR’s Dan Gorenstein reports.

It’s hard to get a handle on exactly how many people in New Hampshire live without insurance.

Some estimate 30 thousand people don’t have health coverage.

One census study put the number much higher, over 100 hundred thousand people.

Traditionally, the plight of the uninsured has been seen as someone else’s problem.

But at a town hall meeting in Manchester, hosted by the Exchange, insurance executives, business representatives, doctors and advocates for the poor agreed the lack of insurance is everybody’s problem.

Part of the challenge is even when there is a health care plan, it might not cover what amounts to preventive care.

One mother told her story.

Track 7
2:35 … My name is Sally Crateau and I come from Stratford, NH. My son is covered under NH Healthy kids, he was told he had to have braces, if he didn’t have braces he would have to have surgery at some point. I can’t afford those braces…it’s not going to happen. Here is a perfect example of being underinsured.

If Crateau can’t afford the braces, finding money for oral surgery is even less likely.

But if her son’s predicament became a crisis, he could get treated at a hospital.

Track 6
:53 the facility would see that as charitable care.

Gray Somers is Vice President and General Manager with Anthem Blue Cross and Blue Shield.

…The way that is financed however is that the individual may not pay anything, we all pay for that through our premiums or some other means. The costs are then shifted to other parties.

The hospital would absorb some of the cost of that oral surgery.

But the rest of it gets built into the hospitals overhead.

That leads to higher bills.

Which in turn lead to higher insurance premiums.

Which are then paid by anyone who has insurance.

But there is another form of cost shifting.

The kind set up by the government.

Non-profit health care facilities, like public health clinics deal with Medicaid payments that always fall short of the real cost of care.

Dr. Rob Nordgren is the executive director of Child Health Services, a non-profit in Manchester.

3:26 … we serve many children who don’t have insurance or access to care, as do community health centers, as we have growing number of uninsured and decreasing gov reimbursement, the stress on that safety net is increasing.

Nordgren is concerned that stress will force other doctors to limit the number of patients they treat who can’t pay in full.

And when people are left with no health care options, that’s when cost shifting is no longer measured in terms of dollars and cents.

Sam Mekrut is with the New Hampshire Citizens Alliance.

She says some uninsured pick up the tab by suffering through their pains.

Track 14
2:37 clearly there are people who are delaying care in much greater numbers. The uninsured delay care. And many report not getting any care for serious conditions. You are 50% less likely to get preventive care if you are uninsured.

Right now the most direct way New Hampshire is dealing with the question of health insurance is in the legislature.

Governor Craig Benson has proposed a 5% reduction in Medicaid reimbursement rates.

Already, the program fails to cover costs.

And it leaves Dr. Jim Squires, President of the Endowment for Health, shaking his head over the coming statehouse debate.

Track 21
1:10 I think we are going ot see a very bitter divisive, angry, hostile dispute over this exact issue. Where one side says we are not going to create any more revenue, and the other side that says we can not allow 119.000 people in our state to go without health insurance.

If there was any consensus at the town hall meeting, it was
that the uninsured need insurance.

Without it, everybody foots the bill.

For NHPR News, I’m DG.