Local health care sector shares flaws seen nationally

From a visitor’s perspective, the gleaming edifice of health care immediately impressed me. At my friend’s room I viewed myriad machines, tubing and monitoring equipment. I spoke to the nurse, who in a very professional manner courteously discussed with the family and me my friend’s progress and the rationale of his treatment. I left with a sense that my friend had received the very best health care for his illness. I was proud to be a small part of the health care environment in Springfield, bringing state-of-the art technology, highly trained health care providers and hospitals to the community.

Health care is the largest employer in the city and serves a population of nearly 1 million. Unfortunately, Springfield represents a microcosm of the national health care environment and, of course, has the same critical flaws.

For most Americans (and Springfieldians), high-quality health care is generally accessible without long waits, but at a high cost. For the insured, this cost is something not experienced. Most Americans operate under the illusion that someone else is paying for their health care.

Predictably, this mass illusion will fade when we have a reality check with the loss of employer-provided health care coverage, increasing co-payments and decreasing federal monies for Medicare, Medicaid and most recently, the State Children’s Health Insurance Program.

There also is a lack of recognition that the uninsured are another source of hidden costs. Nationally, there are 47 million uninsured people, representing 15.8 percent of our population. In Missouri, there are 719,000 uninsured (13 percent of the state’s population), and 8.4 percent of Greene County residents are uninsured.

The uninsured typically do not have access to preventive services and seek care with a health crisis in high-cost emergency rooms, often with illnesses that require intensive care services. Community hospitals are forced to “cost-shift” to continue providing care to the community, resulting in a steep rise in insurance premiums. Cost shifting is one of the major drivers of rising health-care costs, and employers feel this reality acutely through their health insurance programs.

In the United States from 2000 to 2005, the annual average premium for employer-sponsored family health insurance increased 58 percent to $10,728, up from $6,772. Subsequently, there has been a decline in the proportion of people with employer-based health insurance to 59.7 percent in 2006, down from 63.7 percent in 2000. In Missouri, the proportion fell 10 percent to 59 percent in 2006. Employers who have not dropped coverage have been forced to shift to managed care plans, adopt pharmacy benefit management plans and increase cost sharing by employees.

The national health care debate generally is divided into two camps: those who favor a market-driven system and those who desire equity in providing health care. The present administration clearly favors a market-driven approach, but how successful has this approach been? The United States now spends 15.3 percent of its gross domestic product on health care with other industrialized countries spending an average of 9 percent. Our per capita expenditures – $6,401 a year – are far more than any other country.

One would think with such high expenditures, our health care performance would be the best, but sadly this is not the case. The Commonwealth Fund recently performed an international survey looking at 37 indicators to measure health system performance and categorizing these into six broad categories: long, healthy and productive lives; quality; access; efficiency; equity; and capacity to innovate and improve. The United States scored just above average overall, with a score of 66 out of 100.

Economists define market failure as lack of success by a market or a market economy in achieving an efficient allocation of resources. It doesn’t take a rocket scientist, or an economist for that matter, to recognize that the current market-driven health care system is broken, and unless there is significant health care reform, will likely implode within the next 10 years.

What should businesses and citizens do?

On a national level, we should cast a very critical eye toward any candidate who promotes health care reform without addressing our key shortcomings.

On the state level, pay close attention to the MOHealth Plan. Although far from perfect, it does conceptually have meaningful partial remedies for some of the critical problems addressed above.

On a local level, provide support to the evolving community health care summit involving the two major health care systems and promoted by Kevin Gipson, director of the Springfield-Greene County Health Department.

John Mihalevich, MD, FACP, MSHA, is immediate past president of the Greene County Medical Society and a member of its executive council. He may be reached at john.mihalevich@coxhealth.com.