Inpatient care health reform proposal 2

The United States is in great need of health reform. The inpatient sector of health care is suffering and measures need to be taken in order to ensure quality and access to the approximately 308 million individuals living in America. This reform proposal focuses on the role of the hospital in inpatient care. According to the 2006 National Hospital Discharge Survey there are 34.9 million discharges a year from U.S. hospitals. This number does not include the 15.3 million emergency room visits which result in admission into the hospital.¹ One can see that inpatient care is a crucial sector of the health care system. Therefore, a change needs to be made to the health system to not only ensure that inpatient care is maintained but also improved. Something needs to be done about the 47 million people who are permanently uninsured as well as the 43 million who spend a lot of their time uninsured.² According to Ricardo Guggenheim, MD, for HealthLeaders News stated that, “We have an uninsured crisis in our country that is creating great imbalances in the healthcare delivery system. A significant source of this imbalance is the result of the large number of uninsured patients that are turning to hospitals for medical care.” He then continued to explain that the majority of uncompensated care is delivered in hospitals. Hospitals nationwide, in a single year, provide 31.2 billion dollars of uncompensated care. As a result, many health systems face shutting down because they cannot deal with the financial loss they face by providing services which they are not compensated for.² This creates new issues because as the population ages, it is likely that the utilization of inpatient care will rise and we can’t afford to be losing hospitals. We also can’t afford to lose emergency room services because ERs are greatly utilized currently and are already overcrowded. According to the National Hospital Ambulatory Medical Survey there are 119.2 million emergency department visits a year.

It is clear that we need a solution to these financial problems created in inpatient care. The solution: universal coverage. Congress needs to pass a law that ensures that all Americans will have health insurance coverage. This would eliminate the financial burden hospitals currently bear due to uncompensated services. It would also improve access to inpatient care because there would be room for those who truly needed to stay in the hospital. Quality of care for patients in the hospital would also be better because there would likely be fewer patients for each physician to be responsible for. This would occur because, in our current, situation many hospital beds are filled with people who do not actually need emergency care. According to Guggenheim, many uninsured individuals currently use the emergency room for chronic health problems that become uncontrolled. If they are admitted to the hospital, they are released once their condition stabilizes but they will eventually need to be readmitted. Universal coverage will allow these people to get the medications and follow-ups they need to keep their chronic conditions under control and it will alleviate unnecessary hospital use.² According to John S. O’Shea, M.D., “In Maryland, for example, patients with non-urgent medical problems account for over 40 percent of ED visits.” ³

Some individuals believe that providing universal health coverage will create more problems for the health care system than it will fix. They believe that it will create a lot of issues when trying to receive outpatient care because so many more individuals will be accessing care. It may be true that more will seek care with primary physicians, but it will also free up the hospital emergency rooms which are currently overcrowded. Why is this so important? When emergency rooms and hospital beds are filled with individuals who could be treated in an outpatient center, care may be delayed for individuals who need emergency medical attention, which is a much more serious problem than having to wait a few days to see a primary care physician.

This reform proposal is more important that other reforms because it is crucial that hospitals are not closing due to financial burden caused by uncompensated care; this will cause further problems for the health system. The inpatient sector also needs to be taken care of so that the quality of care does not suffer for those who need serious medical attention. It is also important so that access to hospitals improves so that those in serious need can be taken care of.

Sources:

1. Hospital Utilization (in non-Federal short-stay hospitals). Centers for Disease Control and Prevention Web site. http://www.cdc.gov/nchs/FASTATS/hospital.htm. January 18, 2010. Accessed March 9, 2010.

2. Ricardo Guggenheim. Uncompensated Care is a $31 Billion Problem Waiting to Be Solved. HealthLeaders Media Web site. http://www.healthleadersmedia.com/content/220119/topic/WS_HLM2_LED/Uncompensated-Care-is-a-31-Billion-Problem-Waiting-to-Be-Solved.html. September 26, 2008. Accessed March 9, 2010.

3. John S. O’Shea. The Crisis in America’s Emergency Rooms and What Can Be Done. The Heritage Foundation: Leadership for America Web site. http://www.heritage.org/Research/HealthCare/bg2092.cfm . December 28, 2007. Accessed March 9, 2010.

Inpatient Care Reform Proposal 1

According to an article at Health Care Reform.gov, “pre-existing conditions affect millions of Americans”, leaving healthcare unattainable for many of these millions of Americans (5). Congress needs to take action to require insurance companies to accommodate all people with pre-existing conditions. As said by the International Medical Insurance dictionary, pre-existing conditions are defined as “any illness or injury that has manifested symptoms or is known to an individual prior to the start of a policy”. (4) Many insurance companies are currently required to insure people with pre-existing medical conditions, but many do so only with a pre-existing exclusion period, so there is a stretch of time that insurance does not accept claims related to a client’s prior condition. (1) By eliminating these exclusion periods and requiring all insurance companies to insure those people with pre-existing medical conditions, insurance company “cherry-picking” would be more tightly controlled, and insurance companies would cover much more of the currently uninsured population. The Health Insurance Portability and Accountability Act of 1996 (HIPPA) has helped to stop some cherry-picking by preventing discrimination against people with prior medical conditions. The US Department of Labor did a great job explaining how and when HIPPA requires most insurance companies to cover people with pre-existing conditions, but still allows for the varying exclusion period, which can range from six to 18 months (2). Also, under most circumstances, in order to get the “short” exclusion period of six to 18 months, you have to have prior, uninterrupted health insurance, which nearly 50 million Americans unfortunately do not (3). For a cancer or diabetes patient, eighteen months is a very long time to have to cover your own hospital bills.
This reform would undeniably cut down the amount of families that go through medical bankruptcy because more families with diseases and/or conditions requiring frequent medical conditions would be held less accountable for paying for their medical bills out of pocket. Also, access to health insurance would become available to many more people, some which include cancer patients, people with diabetes, and the more and more prevalent problem of patients with high blood pressure. Incorporating this reform into our health care system would better the outcomes of the population because so many more people could receive health care when they need it. This could decrease future health bills because preventative tests/procedures could stabilize the patients’ condition further, leading to less frequent hospital or emergency room visits.
Another current reform is arguing that more money needs to be spent on in-home care rather than long-term care in nursing homes, because long-term care in nursing homes is more expensive for Medicare than in-home care would be. While I feel this is also an important step to consider in our current health care system, I think that we need to focus on getting more people covered by insurance first. If we do not, people with declining health will end up in the nursing homes or in long-term home cares even sooner than they already are, which would cost even more money. People with pre-existing conditions are more likely than healthy people to end up in a long-term care facility anyway, so without getting them health insurance coverage, they will be more at risk to enter into medical bankruptcy, if they can even afford to enter into long-term care at all.
Some people may argue that covering people with pre-existing conditions is not as important as getting the poor and underinsured populations insured. While there may be some relevant points to this, much of the pre-existing conditions population will soon become poor and underinsured, as many of them are already, because insurance will not cover their current medical bills. If we can prevent this from happening, we can keep the poor and/or underinsured population from escalating out of control and once this proposal is put into place, we can turn our attention to the remaining poor/underinsured population.


1. Bihari, MD, Michael. Pre Existing Conditions - Understanding Exclusions and Creditable Coverage. About.com, 8 Feb. 2010. Web. 1 Mar. 2010. http://healthinsurance.about.com/od/healthinsurancebasics/a/preexisting_conditions_overview.htm
2. FAQs About Portability of Health Coverage and HIPPA. United States Department of Labor, n.d. Web. 1 Mar. 2010. .
3. How Pre-Existing Conditions Work. How Stuff Works, 2010. Web. 2 Mar. 2010. .
4. Key Terms and Definitions. International Medical Insurance, 2010. Web. 1 Mar. 2010. .
5. US Department of Health and Human Services. Coverage Denied: How the Current Health Insurance System Leaves Millions Behind. United States Government, 1 Mar. 2010. Web. 1 Mar. 2010. ..