The number of uninsured patients treated at public hospital systems increased 23% from 2008 to 2009, resulting in a severe financial strain on the system that may force hospitals to close their doors, according to the National Association of Public Hospitals and Health Systems.
A NAPH survey of 41 healthcare systems reported a 10% increase in uncompensated care costs, on average, with $2.3 million per member. Some members incurred more than $16 million in costs. The average member reported an increase of at least 2,600 additional uninsured patients in its healthcare system in 2009.
"Increases in utilization by uninsured patients continue to stretch the health systems' limited resources; more than half of all patients seeking care at these health systems are uninsured or covered by Medicaid," the report stated.
The U.S. public hospitals have been left in a "precarious position and Medicaid cuts at the state level will hinder their ability to continue serving as our nation's healthcare safety net," NAPH President Larry Gage said in a written statement. "The impact will weaken the fragile viability of the nation's safety net and force public hospitals to close their doors due to inadequate financing.";
The safety net system refers to facilities that provide a significant level of care to low-income, noninsured or vulnerable populations, often the largest metropolitan systems in the country. These so-called safety net systems in California, Colorado, Florida, Louisiana, Kentucky, New Mexico, Virginia, Washington DC, and Washington State had higher than average increases in uncompensated care costs.
Since early 2008, the Virginia Commonwealth University Health System has seen a demand by uninsured patients for inpatient hospitals services by almost 30%.
"As the current economic crisis continues to threaten the financial viability and health security of families throughout the country, Americans have turned to safety net health systems in increasing numbers," the report stated.
"These hospitals are facing cutbacks and the demand for services is unprecedented," says Lynne Fagnani, senior vice president of the National Association of Public Hospitals and Health Systems. "So these hospitals are the safety net, and when people are down on their luck, this is where they go—the safety net hospitals; and it shows where the demand for hospital is significant. Yet, nationally, hospitals have seen declines in volume [for inpatient and elective services]."
Indeed, fewer patients are seeking inpatient and elective services at hospitals nationwide, but the economic downturn has resulted in a greater proportion of patients without insurance coming through their emergency departments, according to an American Hospital Association survey of hospitals in 2009. People covered by Medicaid and other public programs for those in need are also increasing, the AMA stated.
"With higher unemployment, more folks are losing their insurance coverage and there are more uninsured overall," says Matt Fenwick, spokesman for AHA. "We have a broken healthcare system. You face cuts, you cut administrative staff, there's nothing more you can do. If we don't have reform, hospitals will be facing fundamental issues to keep the doors open. At some point, there's nothing more you can do."
The NAPH survey also found:
- An 18% percent increase of uninsured patients who visited emergency rooms—with 1,200 additional visits per member. The health systems in California, Colorado, Massachusetts, Ohio, and Washington DC reported higher than average increases in emergency room visits by uninsured patients.
- A 15% increase of uninsured patients also accessing non-emergency outpatient hospital services, including primary care. Systems in Alabama, California, Washington DC, Illinois, Missouri, Ohio, and Virginia all reported higher than average increases. The report noted: "These increases in utilization by uninsured patients continue to stretch the health systems' limited resources—more than half of all patients seeking care at these health systems are uninsured or covered by Medicaid."
In its report, NAPH recommended that Congress "enact comprehensive healthcare reform to ensure universal access to care" and provide additional funding to safety net hospitals and states.
NAPH includes more than 140 hospitals within 81 health systems, such as the New York City Health and Hospitals Corp., and the Cook County Bureau of Health Services. NAPH members represent 2% of hospitals nationwide, but provide 21% of all hospital-based uncompensated care.
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
