This is a web-exclusive article on the theme “Education: Restorative justice.” For more stories on this theme, see the January issue of The Mennonite. I have […]
This is a web-exclusive article on the theme “Faith-filled responses to health-care costs.” For more stories on this theme, see the September issue of The Mennonite.
Unhealthy in America. These words came to me as I reflected on my life as a consumer, licensed care giver, manager and board member, and hospital executive.
My experience as a consumer must be prefaced with this disclosure: I have been blessed. From my first purchase of health-care insurance in the early 1980s for less than $500 per year, to a lifetime of employer-paid health-care coverage, to a retirement phase where I can afford to purchase necessary coverage.
Much has changed since the low-cost insurance of the early ’80s. This includes the present day reality of annual family plan costs of $20,000 premiums with $15,000 deductibles. With published median U.S. family income of $73,891, a potential alarming percentage of household income is devoted to health care.
My health-care delivery experience has spanned the range from the fee-for-services days, the introduction of Medicare Diagnostic Related Groups (DRGs), the age of Health Management Organizations (HMOs), to our present day complicated government and private payment schemes.
Through all of this, provider patient and hospital patient relationships and decisions have been superseded by government payment, compliance and delivery regulations. The private market has interrupted these relationships through preauthorization, retrospective payment denial and reimbursement reductions.
Over time, organizations are required to dedicate more resources to case management, finance departments and business operations. This certainly and sadly shift precious resources from patient care to these growing departments. These shifts are contradictory to many organizational statements of mission.
I would be remiss not to mention the regulations and standards placed on providers and hospitals across the country. The current Centers for Medicare & Medicaid Services manual has nearly 1,200 sections and accrediting and state agencies include thousands of additional standards and elements of performance.
Do all of these standards and regulations lead to a better health-care system? There is a dedicated group of professionals, of which I am part of with the credential of Certified Professional in Healthcare Quality, dedicated to delivering a quality health-care experience and outcome. Regardless of this dedication and growth in regulations, the number of medical errors has not declined as intended. Is this the result of shifting resources from care to business for survival purposes? Perhaps.
Where we go as a country will depend on our willingness to make sense of our health-care delivery and financing system. Our present system stymies business startups, shifts more cost to the consumer and forces individuals and families to make difficult decisions based on cost and not need. An argument could be made that health-care costs and access is the single largest risk point to this generation.
We must have a nonpolitical, compassion-focused discussion to restore health to our health-care system. While nothing is free, what is the cost of an unhealthy America?
Craig Saylor is a retired CEO from acute care healthcare delivery and is active in health-care governance, health-care quality and analytics. He is part of Carpenter Park Mennonite Church in Davidsville, Pennsylvania.
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