About Healthy Kids: In the News
Is California's health care reeling toward a crisis? Costs, insured plague a system trying to cope
Published on November 29, 2005
Brad Bollinger, North Bay Business Journal Editor
Many hospitals in the North Bay are expanding or planning entirely new facilities costing hundreds of millions. The red ink of the early 2000s and the spectacular financial failures of physician groups and insurers are absent.
It would appear things in the health care system are OK, if not perfect. But they are not. If health care in California and the North Bay were a patient, it would be in "stable but critical condition." Just consider these cracks in the foundation of the system:
-- The number of California residents who receive employer-based health care insurance fell in 2004, according to a recent study by the Oakland-based California Health Care Foundation. In 2000, 59.1 percent of residents got their health benefits from their employer. In 2004, only 54.7 percent did. Nationwide, 62.4 percent of people get their insurance from their employer, according to the non-profit foundation, which studies issues related to health care access.
-- The number of uninsured in California was unchanged at 20.9 percent. But that occurred mainly because more people were receiving Medicaid, Medicare or purchased insurance on their own.
-- More than half of the uninsured are Latino. Twenty percent of the uninsured work for large employers with at least 500 employees. Nearly a third of California's uninsured have family incomes of $50,000 or more.
6.5 million without insurance
-- California has the largest number of uninsured in the nation at about 6.5 million and the eighth-largest proportion of residents without insurance.
For the North Bay, providing quality health care for both the insured and uninsured – while staying afloat financially – is a daily challenge.
Preparing for Thursday's health care conference sponsored by the BUSINESS JOURNAL (this column was written before the event), the severity of the challenge was readily apparent.
For instance, at Memorial Hospital, less than 30 percent of the patients or their insurers pay the full cost of the care they receive.
Meanwhile, as Sutter Medical Center of Santa Rosa moves forward with plans for a new state-of-the-art hospital near the Luther Burbank Center for the Arts, long-existing patterns of how the uninsured and poor in Sonoma County get treatment are sure to be disrupted.
What will be the impact of that shift not just on Sutter, but on Memorial? And what will be the role of Kaiser Permanente in treating the uninsured?
Trying to help 8,000 uninsured kids
Some good things already are happening on the uninsured front. All three hospitals are cooperating on the promising Children's Health Initiative dedicated to extending care to Sonoma County's 8,000 uninsured young.
Surely there must be other opportunities for collaboration. For instance, why should a patient within a large system be sent out of county to receive a treatment that is available from a local provider if at only a slightly higher cost?
In addition, more and more health care leaders are talking about creating "transparency" in the health system so consumers can see what their treatment actually costs.
But as each day passes, financial and other strains are increasing for medical providers, consumers, employers and insurers.
An estimated 60 percent of doctors in Sonoma County have stopped taking new Medicare patients. A recent denial of a modest increase in Sonoma County's outmoded "rural" reimbursement schedule likely will only make matters worse for seniors and doctors.
In other words, the health care patient today may appear stable, except perhaps for rapidly rising insurance premiums. But below the surface, the system is in increasingly critical condition and is desperately in need of the kinds of solutions that come from broad local collaboration and innovation.
Brad Bollinger is editor of the Business Journal. He can be reached at bbollinger@northbaybusinessjournal.com or (707) 579-2900. ext. 201.