National Association of Public Hospitals Thesis

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National Association of Public Hospitals and Health Systems' Position on Uninsured Healthcare Consumers

Today, the National Association of Public Hospitals and Health Systems (NAPHSS) provides more than $6 billion in unreimbursed healthcare services to healthcare consumers in the United States and operates a number of emergency rooms and ambulatory care facilities that represent the only access to healthcare for many people. Together with the Department of Veterans Affairs, the NAPHSS is also responsible for training many of the healthcare practitioners that go on to make substantive contributions to the nation's healthcare system. Clearly, the NAPHSS represents an important component of the nation's healthcare system, but the manner in which these hospitals are funded and the amounts they receive make the problem of continuing to provide care for millions of uninsured Americans especially challenging. This paper provides an analysis and discussion concerning the position that the NAPHHS has taken on the policy issue/problem of uninsured healthcare consumers in the United States. A summary of the research and important findings are presented in the conclusion.

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Thesis on National Association of Public Hospitals Assignment

According to Kovner and Knickman, public hospitals in the United States are characterized by their receipt of financial support from the local, state or federal government, besides the reimbursement received from Medicaid and Medicare. These authors report that, "The National Association of Public Hospitals and Health Systems (NAPHHS) has more than 100 member hospitals in 30 states and includes hospitals in our largest cities, such as Bellevue in New York, Cook County in Chicago, and LA County in Los Angeles. NAPHHS categorizes its members into three models of governance: direct operation by local or state governments, operation by a separate public entity, or ownership and operation by a not-for-profit corporation" (p. 228). Hospitals operated by the NAPHHS tend to be larger than their private counterparts, and their emergency rooms and ambulatory clinics are extremely busy places. These hospitals have also experienced a 26% increase in their workloads since 1993 (Kovner & Knickman). According to Kovner and Knickman, "Public hospitals have been referred to as 'safety net hospitals' because they provide significant services to uninsured, underinsured, or other vulnerable populations, and offer services to all -- regardless of ability to pay -- as part of the hospital's mission or legal mandate" (p. 228).

The NAPHSS organizational Web site emphasizes the importance of public hospitals to the nation's overall healthcare system. For instance, the NAPHSS:

1. Operates many of the nation's burn, trauma, and poison centers;

2. Serves as first receivers in times of crisis, from disasters to epidemics;

3. Provides close to $6 billion per year in uncompensated hospital care;

4. Is a major provider of ambulatory care along with community health centers;

5. Conducts world-class medical research and offer the latest procedures and technology;

6. Trains more than 11,000 healthcare professionals each year;

7. Provides almost 71,000 emergency department visits per year at each facility;

8. Employs more than 230,000 people nationwide; and,

9. Provides culturally competent care to diverse populations with a workforce that reflects this diversity (Public hospitals and health systems: A responsible investment, 2008).

Consequently, one of the biggest problems facing the NAPHSS today is the fact that the number of Americans without healthcare insurance continues to increase even as the demand for healthcare services continues to grow. In this regard, Bloche (2003) reports that, "The most significant pressure on public teaching hospitals stems from increasing numbers of uninsured. Even in the strong economy of the late 1990s, when the number of uninsured appeared to level off, many of the new jobs created were in small businesses or service industries which do not traditionally provide adequate insurance coverage" (p. 162). In recent years, the shaky national economy has resulted in increased unemployment across the country, with the concomitant fear that the number of uninsured healthcare consumers will continue to increase to untenable levels (Bloche). Furthermore, as Bloche emphasizes, "In good times and bad, lower-income workers often refuse coverage even when it is offered if substantial cost-sharing is involved" (p. 162).

Explain the group's position.

According to the organizational Web site maintained by the NAPHSS, Medicaid represents the largest component of the financial support that allows public hospitals to meet the gaps in healthcare in their communities. For example:

1. Medicaid reimbursement is the largest single source of revenue.

2. Medicaid Disproportionate Share Hospital (DSH) payments support a significant portion of the unreimbursed care provided by public hospitals, but DSH funding is falling ever further behind the growth in the cost of providing medical care for the uninsured.

3. Without Medicaid DSH and other supplemental payments, public hospital margins would be an unsustainable negative 11.4%.

4. The 340B drug discount program allows public hospitals to provide thousands of low-income patients with access to affordable outpatient drugs (Public hospitals and health systems: A responsible investment, 2008, p. 1).

In order to provide a sustainable system of "safety net hospitals" across the country, it is the position of the NAPHSS that the following initiatives and actions need to be undertaken by lawmakers at the earliest opportunity:

1. Urge the federal government not to implement limits on Medicaid payments that would hurt public hospitals.

2. Urge Secretary Leavitt to implement the citizenship verification provision of the DRA in a way that avoids denying Medicaid coverage to eligible U.S. citizens.

3. Ensure that the nation's immigration policies do not penalize healthcare providers for maintaining access for all, including immigrants.

4. Co-sponsor the Safety Net Inpatient Drug Affordability Act (H.R. 3547 or S. 1840), which would extend the 340B drug discount program to inpatient pharmaceuticals (Public hospitals and health systems: A responsible investment, 2008).

Explain what rationale (if any) the group has given for its position. Has it provided clear evidence or other support for its position? What do you think accounts for the group's approach to the issue?

According to Larry Gage, president of the National Association of Public Hospitals and Health Systems suggests that the question of regulating managed care tend to overlook the more fundamental problem confronting healthcare consumers in the United States: "The plight of the forty-three million uninsured" (quoted in Altman, Reinhardt & Shactman, 1999 at p. 206). In this regard, President Gage notes that lower reimbursement by private health plans in addition to federal government cutbacks threaten the financial stability of safety-net providers that currently provide healthcare for these uninsured citizens. Furthermore, Gage maintains that additional resources must be contributed by the entire national healthcare system, including managed care plans, in order to sustain the institutional health safety net and recommends that disproportionate share payments be included in Medicare managed care premiums (Altman et al.). To this end, Gage has called for the creation of a national indigent care trust fund and concludes that with a healthcare system that leaves 43,000,000 Americans uninsured, the nation does not enjoy the luxury of limiting the policy debate to protecting those who already have insurance (cited in Altman et al.).

Evaluate and discuss the group's position. Why should the group take on this position? Why should the group not take this position?

Complex problems clearly require complex solutions and the issues facing the NAPHHS are certainly no exception. While it may not take a smart person to recognize the serious problems that face the NAPHHS today, it is going to take some smart people to figure out what to do about them. Unfortunately, because resources are by definition scarce, there is only so much taxpayer money available to support the NAPHSS and its far-flung operations. Nevertheless, there is more involved in this analysis than the mere numbers reflect, and the health and well-being of 43,000,000 Americans is what is really at stake. While the pundits continue to debate the efficacy of one healthcare alternative over another, these millions of Americans continue… [END OF PREVIEW] . . . READ MORE

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