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15 October 2007
at 2:32 p.m.
Just some thoughts from someone who likes to GOOGLE.
Taxes are no fun and I can understand from previous posts that nobody wants them. When they are all added up they can amount to a lot of money. While I don't want my taxes to go up either it just seems like it is a necessary evil in this case. Keep in mind that this hospital is a county owned hospital. The county took on this roll a number of years ago (50+), just like most counties in the West. More hospitals in the Western U.S. are county owned than private owned or non profit. Just south of us Rio Blanco citizens contibute over a million bucks a year just for one of it's two hospitals and I believe over $2.5 million between the two of them (They have hospital districts down there).
Unlike the hospital in Meeker, TMH has a critical access status which does allow it to have a slightly better payment system from Medicare (most studies around 2000 suggested that becoming critical access increased gross margin percentage from -1% up to between +1.5% to +3% on the average rural hospital — I think that is the difference between choosing to pay your power bill or buy food) The hospital can recognize the a portion of both depreciation and interest as an actual cost when they deal with Medicare. Not just this hospital, but all small hospitals that are organized as a critical access hospital. Seems weird, but that's how its been set up. When Medicare was first established back in the 60s it was cost based reimbursement. Into the early 80s a lot of hospitals expanded due to the fact that everyone was reimbursed based on cost (All had an incentive to build it bigger). Then they shut down cost based reimbursement in 83 and started paying hospitals under a different system. During the late 80s and early 90s a lot of small hospitals went out of business. Then in the late 90s they reintroduced cost based reimbursement for small hospitals because too many were going under (Hundreds closed their doors — See OBRA 1997). What it has done is allowed a lot of small hospitals to use this payment system to fund new hospitals (literally hundreds across the country have been built because of this). However, some seem to think that it is getting out of control and is starting to be a burden on Medicare and will have to be modified or eliminated at some point in the future (maybe ten years out — Medicare likes to reinvent it self about every 15 years or so (1965, 1983, 1997, 20??).
14 October 2007
at 5:15 p.m.
Many aspects that make a free market system produce cost savings are actually starting to transpire. Many hospitals and physicians are starting to advertise their prices up front. A consumer can compare different services based on price (Etna, an insurance group was the first organization the published the prices that they are paying doctors for certain services). Also, states like Arizona and Minnesota are working to make physician and hospital outcomes public record (so you can see who does the best job). Too much competition can actually be a bad thing in some cases. Like if every doctor/hospital ran out and bought a high-tech piece of equipment and then thier break-even price based on utilization projections would actually drive the cost up, as compared to having a market with a limited number of participants with government established price controls.
One big source for you to look at would be the Institute of Medicine's “Crossing the Quality Chasm” This will get you on your way to see how many people are killed every year in the U.S. due to errors. Many reports have come out since that study to suggest that they under estimated by over double. Also look at the Leapfrog Group at www.leapfroggroup.org, Christopher Wanjen's “Bad Medicine” book that talks about access and outcomes, the National Coalition on Health Care website at www.nchc.cost (seach “GDP”), USA Today (www.usatoday.com/money/autos/2005-06-… ) to see how GM spent more on steel, and www.HFMA.org and search “medical-tourism”) it has some pretty good ideas.
However, to back up what you are saying about a more free market system for healthcare, Harvard Business professor Michael Porter's “Redefining Healthcare” helps substantiate some of your ideas, but doesn't call for a full withdrawl of government intervention.
14 October 2007
at 9:55 a.m.
Jason, Do ou have medical insurance? Over 40 Million American don't. Medical bills are the second leading cause of personal bankruptcy next to divorce. In many urban areas it takes upwards of 8 hours to be seen by a physician in an emergency room. Most of those people didn't go see a doctor before the illness got serious, because they couldn't afford a doctors visit and many doctors won't see you if you don't have insurance or can pay for the office visit at the time of service. Our nation almost spends as much per year, as a percentage of GDP, as it did on the war effort during World War II. GM now spends more money on insuring its workers than it spends on the steel that goes into its cars every year. Some estimate that somewhere between 200,000 and 300,000 people are dying every year due to medical errors in the U.S.. And England, Germany, and Japan spend less than we do with socialized medicine and they live on average about three years longer than the average American. By many estimations, we have almost as many Americans going overseas to get medical procedures as we do wealthy foreigners coming to the U.S. for care. Are pockets of the U.S. system the best in the world? Undoubtedly! But you better bring your check book!
13 October 2007
at 12:40 p.m.
What happens to our medicare payments when they get rid of the critical access hospital payment plan? If you google it you see that they started it back in the 90s to help keep certain hospitals from going out of business. Many of the web sites say that it costs medicare too much money and will go away in less than ten years because so many small hospitals are building new ones and medicare is paying for it. How will the hospital make its payments if this happens?
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