Comments on: HOSPITALS: “Soak the Poor:” Uninsured Hit With Higher Hospital Bills http://healthaffairs.org/blog/2007/05/09/hospitals-soak-the-poor-uninsured-hit-with-higher-hospital-bills/ The Policy Journal of the Health Sphere Fri, 20 Nov 2009 20:04:42 -0500 hourly 1 By: Health Affairs Blog http://healthaffairs.org/blog/2007/05/09/hospitals-soak-the-poor-uninsured-hit-with-higher-hospital-bills/comment-page-1/#comment-2680 Health Affairs Blog Mon, 04 Jun 2007 21:37:05 +0000 http://healthaffairs.org/blog/2007/05/09/hospitals-soak-the-poor-uninsured-hit-with-higher-hospital-bills/#comment-2680 [...] HOSPITALS: “Soak The Poor:” Uninsured Hit With Higher Hospital Bills by Jane Hiebert-White [...] [...] HOSPITALS: “Soak The Poor:” Uninsured Hit With Higher Hospital Bills by Jane Hiebert-White [...]

]]> By: Health Disparities & Bioethics » Blog Archives » Uninsured Hit With Higher Hospital Bills http://healthaffairs.org/blog/2007/05/09/hospitals-soak-the-poor-uninsured-hit-with-higher-hospital-bills/comment-page-1/#comment-2567 Health Disparities & Bioethics » Blog Archives » Uninsured Hit With Higher Hospital Bills Fri, 25 May 2007 15:21:10 +0000 http://healthaffairs.org/blog/2007/05/09/hospitals-soak-the-poor-uninsured-hit-with-higher-hospital-bills/#comment-2567 [...] On the Health Affairs blog an article titled “HOSPITALS: “Soak the Poor:” Uninsured Hit With Higher Hospital Bills” has this to say:Uninsured patients are billed on average 2.5 times more than insured patients and 3 times more than Medicare patients for hospital care, according to a new study published in Health Affairs. Professor Gerard F. Anderson of the Johns Hopkins Bloomberg School of Public Health writes: “Fifty years ago the poor and uninsured were often charged the lowest prices for medical services.” Today this pricing policy is reversed, and the gaps are widening from what they were in the mid-1980s. more… [...] [...] On the Health Affairs blog an article titled “HOSPITALS: “Soak the Poor:” Uninsured Hit With Higher Hospital Bills” has this to say:Uninsured patients are billed on average 2.5 times more than insured patients and 3 times more than Medicare patients for hospital care, according to a new study published in Health Affairs. Professor Gerard F. Anderson of the Johns Hopkins Bloomberg School of Public Health writes: “Fifty years ago the poor and uninsured were often charged the lowest prices for medical services.” Today this pricing policy is reversed, and the gaps are widening from what they were in the mid-1980s. more… [...]

]]> By: Jane Hiebert-White http://healthaffairs.org/blog/2007/05/09/hospitals-soak-the-poor-uninsured-hit-with-higher-hospital-bills/comment-page-1/#comment-2506 Jane Hiebert-White Fri, 18 May 2007 15:06:06 +0000 http://healthaffairs.org/blog/2007/05/09/hospitals-soak-the-poor-uninsured-hit-with-higher-hospital-bills/#comment-2506 Thanks, Dr. Ozeran, for your comments. Actually, I agree with you that American society has NOT made it abundantly clear that it should “provide at least a minimum level of protection to its most vulnerable citizens.” I quoted that excerpt from a 1985 introduction to a paper in Health Affairs as a stark reminder of how the past 20 years of evolution in our health care system has still left sizeable and growing gaps. The level of uninsured Americans has grown from 30 million to 44 million in that time. Health Affairs is planning to devote its September/October 2007 issue to the theme of "vulnerable populations." So stay tuned for further debate and proposals on this topic. Thanks, Dr. Ozeran, for your comments. Actually, I agree with you that American society has NOT made it abundantly clear that it should “provide at least a minimum level of protection to its most vulnerable citizens.” I quoted that excerpt from a 1985 introduction to a paper in Health Affairs as a stark reminder of how the past 20 years of evolution in our health care system has still left sizeable and growing gaps. The level of uninsured Americans has grown from 30 million to 44 million in that time. Health Affairs is planning to devote its September/October 2007 issue to the theme of “vulnerable populations.” So stay tuned for further debate and proposals on this topic.

]]> By: L Ozeran http://healthaffairs.org/blog/2007/05/09/hospitals-soak-the-poor-uninsured-hit-with-higher-hospital-bills/comment-page-1/#comment-2503 L Ozeran Fri, 18 May 2007 06:20:15 +0000 http://healthaffairs.org/blog/2007/05/09/hospitals-soak-the-poor-uninsured-hit-with-higher-hospital-bills/#comment-2503 While the data presented in Ms. Hiebert-White's 5/17 post may be accurate, I don't know that the conclusion is complete. As insurers, public and private, have paid for less of the cost of care, the uninsured have certainly been *requested* to pay more. However, often they do not do so and it is the provider of the service who ultimately pays by being uncompensated. This has led to the majority of California ERs losing money and numerous medical groups going out of business. I have a lengthy discussion of our healthcare crisis at my website http://www.DrOzeran.com/policy.php which discusses another perspective on how we got to where we are and what we ought to do. One implication I strongly disagree with is that "the American society has decided..to provide at least a minimum level of protection to its most vulnerable citizens." I believe that we ought to do so and thus far have failed to do so because society has chosen *not* to pay for it. Of note, it has been estimated that insuring the uninsured would ultimately save $180 Billion annually, theoretically enough to cover the cost of insurance. The theory is based upon the presumption that with insurance individuals would obtain timely care (outside of ERs) and costs would drop as quality rose. While I agree with the theory, it is a change that would not occur immediately for many reasons. The two biggest reasons for a delayed effect are the relative increase in physicians that would be needed in primary care and the behavioral adjustment by individuals that would be required. It would be somewhat akin to the push to encourage women to obtain timely mammograms. While widespread today, it was relatively uncommon not too many years ago. While the data presented in Ms. Hiebert-White’s 5/17 post may be accurate, I don’t know that the conclusion is complete. As insurers, public and private, have paid for less of the cost of care, the uninsured have certainly been *requested* to pay more. However, often they do not do so and it is the provider of the service who ultimately pays by being uncompensated. This has led to the majority of California ERs losing money and numerous medical groups going out of business. I have a lengthy discussion of our healthcare crisis at my website http://www.DrOzeran.com/policy.php which discusses another perspective on how we got to where we are and what we ought to do.

One implication I strongly disagree with is that “the American society has decided..to provide at least a minimum level of protection to its most vulnerable citizens.” I believe that we ought to do so and thus far have failed to do so because society has chosen *not* to pay for it. Of note, it has been estimated that insuring the uninsured would ultimately save $180 Billion annually, theoretically enough to cover the cost of insurance. The theory is based upon the presumption that with insurance individuals would obtain timely care (outside of ERs) and costs would drop as quality rose. While I agree with the theory, it is a change that would not occur immediately for many reasons. The two biggest reasons for a delayed effect are the relative increase in physicians that would be needed in primary care and the behavioral adjustment by individuals that would be required. It would be somewhat akin to the push to encourage women to obtain timely mammograms. While widespread today, it was relatively uncommon not too many years ago.

]]> By: Jane Hiebert-White http://healthaffairs.org/blog/2007/05/09/hospitals-soak-the-poor-uninsured-hit-with-higher-hospital-bills/comment-page-1/#comment-2497 Jane Hiebert-White Thu, 17 May 2007 16:44:55 +0000 http://healthaffairs.org/blog/2007/05/09/hospitals-soak-the-poor-uninsured-hit-with-higher-hospital-bills/#comment-2497 It is interesting how the same data can paint different pictures of what is going on in the health care system. The hospital pricing trend data for uninsured patients can: 1) highlight the need to get more Americans insured, and 2) illuminate the differential between price and payment. But a key point that the author, Jerry Anderson, points out is the wholesale shift over decades where in earlier years, the uninsured were billed the lowest price. The cost of their care was "cost-shifted" to the insurers (both public and private). As insurers now negotiate the "best" price, how do we handle the fall-out for the uninsured, self-pay patients who are billed "retail?" In a "classic" Health Affairs paper [free access] from the journal's first year of publication, <a href="http://content.healthaffairs.org/cgi/reprint/2/2/20" rel="nofollow" rel="nofollow">Jack Meyer and William Johnson</a> look at the cost-shifting of the late 1970s and early 1980s. In the Prologue to the article, editor John Iglehart writes: "The commercial health insurance industry and, to some extent, large employers have sharply attacked government policies that have led hospitals to shift costs to private patients because of inadequate payment from Medicare and Medicaid. The industry estimates that these cost shifts now total $6 billion. But the industry has not paid attention to another question. If the American society has decided, as it surely has, to provide at least a minimum level of protection to its most vulnerable citizens, how should that protection be financed?" And economists <a href="http://content.healthaffairs.org/cgi/reprint/4/3/67" rel="nofollow" rel="nofollow">Judy Feder and Jack Hadley</a> write in the mid-80s on cost-shifting and the uninsured [free access paper]. The article Prologue states: "One of the most vexing challenges facing the U.S. health care system today is how to care for people who lack health insurance, a population that now numbers about 30 milion...With the implementation of Medicare's prospective payment system, many analysts believed that hospitals would compensate for government reductions in revenue by increasing their charges to privately insured patients." Today, over 20 years later with some 14 million more uninsured Americans, the cost-shift is not to the privately insured, but to the nation's growing uninsured population. It is interesting how the same data can paint different pictures of what is going on in the health care system. The hospital pricing trend data for uninsured patients can: 1) highlight the need to get more Americans insured, and 2) illuminate the differential between price and payment. But a key point that the author, Jerry Anderson, points out is the wholesale shift over decades where in earlier years, the uninsured were billed the lowest price. The cost of their care was “cost-shifted” to the insurers (both public and private). As insurers now negotiate the “best” price, how do we handle the fall-out for the uninsured, self-pay patients who are billed “retail?”

In a “classic” Health Affairs paper [free access] from the journal’s first year of publication, Jack Meyer and William Johnson look at the cost-shifting of the late 1970s and early 1980s. In the Prologue to the article, editor John Iglehart writes: “The commercial health insurance industry and, to some extent, large employers have sharply attacked government policies that have led hospitals to shift costs to private patients because of inadequate payment from Medicare and Medicaid. The industry estimates that these cost shifts now total $6 billion. But the industry has not paid attention to another question. If the American society has decided, as it surely has, to provide at least a minimum level of protection to its most vulnerable citizens, how should that protection be financed?”

And economists Judy Feder and Jack Hadley write in the mid-80s on cost-shifting and the uninsured [free access paper]. The article Prologue states: “One of the most vexing challenges facing the U.S. health care system today is how to care for people who lack health insurance, a population that now numbers about 30 milion…With the implementation of Medicare’s prospective payment system, many analysts believed that hospitals would compensate for government reductions in revenue by increasing their charges to privately insured patients.”

Today, over 20 years later with some 14 million more uninsured Americans, the cost-shift is not to the privately insured, but to the nation’s growing uninsured population.

]]> By: InsureBlog http://healthaffairs.org/blog/2007/05/09/hospitals-soak-the-poor-uninsured-hit-with-higher-hospital-bills/comment-page-1/#comment-2492 InsureBlog Wed, 16 May 2007 17:51:38 +0000 http://healthaffairs.org/blog/2007/05/09/hospitals-soak-the-poor-uninsured-hit-with-higher-hospital-bills/#comment-2492 <strong>Health Wonk Review is up...</strong> One of my favorite things about the medblogosphere is how bloggers can take away something completely different from the same data. Jane Hiebert-White of the Health Affairs blog looks at the same USA Today article as I did, and draws completely diffe... Health Wonk Review is up…

One of my favorite things about the medblogosphere is how bloggers can take away something completely different from the same data. Jane Hiebert-White of the Health Affairs blog looks at the same USA Today article as I did, and draws completely diffe…

]]> By: lozeran http://healthaffairs.org/blog/2007/05/09/hospitals-soak-the-poor-uninsured-hit-with-higher-hospital-bills/comment-page-1/#comment-2486 lozeran Tue, 15 May 2007 00:22:48 +0000 http://healthaffairs.org/blog/2007/05/09/hospitals-soak-the-poor-uninsured-hit-with-higher-hospital-bills/#comment-2486 While there is a retail / wholesale differential applied to individuals vs. insurers, the bigger issue (as relates to the findings of this study) may be the severe underpayment by government payers. If Medicare pays at or below cost, using it as a suggested level of reasonable pricing is nonsensical. If individuals paid 40% of the bill regardless of the level, then it would benefit hospitals to charge more. Since that is unlikely, it would be rational as we move toward broader use of high deductible health plans for hospitals to begin to look at more appropriate pricing. However, do not expect pricing at the retail level to be below 2 x Medicare while Medicare payments remain inadequate. While there is a retail / wholesale differential applied to individuals vs. insurers, the bigger issue (as relates to the findings of this study) may be the severe underpayment by government payers. If Medicare pays at or below cost, using it as a suggested level of reasonable pricing is nonsensical. If individuals paid 40% of the bill regardless of the level, then it would benefit hospitals to charge more. Since that is unlikely, it would be rational as we move toward broader use of high deductible health plans for hospitals to begin to look at more appropriate pricing. However, do not expect pricing at the retail level to be below 2 x Medicare while Medicare payments remain inadequate.

]]> By: David L Rabin MD http://healthaffairs.org/blog/2007/05/09/hospitals-soak-the-poor-uninsured-hit-with-higher-hospital-bills/comment-page-1/#comment-2475 David L Rabin MD Thu, 10 May 2007 18:42:18 +0000 http://healthaffairs.org/blog/2007/05/09/hospitals-soak-the-poor-uninsured-hit-with-higher-hospital-bills/#comment-2475 Universal insurance when, if, and for as long as it is implemented by states, will address part of the problem by reducing the number of state residents uninsured. Hospitals in these states will still be visited by uninsured from other states and uninsured immigrants, who will face these untenable charges. More significantly many low and middle income insured will be insured under state universal insurance, through the more affordable high deductible plans. These plans assure presentation of disease in more advanced states, increasing need for high cost services, and as the insurance cap is reached, precipitating bankruptcy and unpaid bills. Health care is now the the most common cause of bankruptcy even among the insured - and that was before we had much high deductible insurance! National approaches to the problem of the uninsured are needed as are sustainable national approaches to the increasing numbers of the uninsured and the underinsured whose numbers are increasing rapidly under the current vogue of consumer directed health care. Universal insurance when, if, and for as long as it is implemented by states, will address part of the problem by reducing the number of state residents uninsured. Hospitals in these states will still be visited by uninsured from other states and uninsured immigrants, who will face these untenable charges. More significantly many low and middle income insured will be insured under state universal insurance, through the more affordable high deductible plans. These plans assure presentation of disease in more advanced states, increasing need for high cost services, and as the insurance cap is reached, precipitating bankruptcy and unpaid bills. Health care is now the the most common cause of bankruptcy even among the insured – and that was before we had much high deductible insurance!
National approaches to the problem of the uninsured are needed as are sustainable national approaches to the increasing numbers of the uninsured and the underinsured whose numbers are increasing rapidly under the current vogue of consumer directed health care.

]]> By: 24/7 Quote US - Insurance Blog » Blog Archive » Health Companies Soak the Poor - According to Health Affairs Blog http://healthaffairs.org/blog/2007/05/09/hospitals-soak-the-poor-uninsured-hit-with-higher-hospital-bills/comment-page-1/#comment-2474 24/7 Quote US - Insurance Blog » Blog Archive » Health Companies Soak the Poor - According to Health Affairs Blog Thu, 10 May 2007 17:00:43 +0000 http://healthaffairs.org/blog/2007/05/09/hospitals-soak-the-poor-uninsured-hit-with-higher-hospital-bills/#comment-2474 [...] I have seen this before, but the Health Affairs Blog just posted a new article. Those without insurance pay 2.5 to 3 times as much for health insurance as the uninsured do. As an insurance agent, I learned that most people with health insurance belong to a network. In other words the doctors on your ppo or hmo are considered a network, and they agree to charge pre negotiated rates for services. [...] [...] I have seen this before, but the Health Affairs Blog just posted a new article. Those without insurance pay 2.5 to 3 times as much for health insurance as the uninsured do. As an insurance agent, I learned that most people with health insurance belong to a network. In other words the doctors on your ppo or hmo are considered a network, and they agree to charge pre negotiated rates for services. [...]

]]> By: Neil Gardner http://healthaffairs.org/blog/2007/05/09/hospitals-soak-the-poor-uninsured-hit-with-higher-hospital-bills/comment-page-1/#comment-2473 Neil Gardner Thu, 10 May 2007 15:39:33 +0000 http://healthaffairs.org/blog/2007/05/09/hospitals-soak-the-poor-uninsured-hit-with-higher-hospital-bills/#comment-2473 I don't think it is just the poor who are so treated, but anyone out there facing the medical-industrial complex on their own! So much for consumer directed healthcare! Individual consumers are no match for the medical-industrial complex, but just like any other unionization process, the field can be evened out by reversing the divide and conquer attitude of those wishing to make only money period! I don’t think it is just the poor who are so treated, but anyone out there facing the medical-industrial complex on their own! So much for consumer directed healthcare!

Individual consumers are no match for the medical-industrial complex, but
just like any other unionization process, the field can be evened out by
reversing the divide and conquer attitude of those wishing to make only
money period!

]]>