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Hahnemann University Hospital, a 496 bed major teaching hospital in Philadelphia, is closing its doors. It treats inner city residents both US citizens and aliens (legal and otherwise) who cannot pay for their treatment. Its other big mission is training residents and fellows who will then fan out to other parts of the USA. It has over 500 resident doctors who must scramble to find new teaching hospitals. It also has more than 2,5000 other employees who will loose their jobs.
This is a tragedy and a reminder of why "Obamacare" is a grossly inadequate solution to the US healthcare crisis.
You really don't understand how various nations fund their universal healthcare plans. In Canada...
That's not how it works in the EU-28, which is what I directly compared: the effective US Federal income tax rate a US average income household pays to that of an average income household in the EU-28.
And Canada? People have to buy supplementary private health insurance in Canada to get full coverage. 75% of Canadians have some form of supplementary private health insurance (source OECD), so... FAIL.
That's not how it works in the EU-28, which is what I directly compared: the effective US Federal income tax rate a US average income household pays to that of an average income household in the EU-28.
And Canada? People have to buy supplementary private health insurance in Canada to get full coverage. 75% of Canadians have some form of supplementary private health insurance (source OECD), so... FAIL.
The supplementary insurance is used for prescriptions, dental and optical. Not primary or necessary medical care.
Did some research on Hahnemann University Hospital, and things are pretty much as one stated.
"The hospital, after executing short-time extensions with private payers after the leadership change, has not had any success in getting commercial insurers to negotiate new contracts.
Volume has dropped from an average of 300 patients per day to between 200 to 250, which has made it difficult to cover the costs of the 24-hour-a-day staffing levels required for the high-end services the hospital provides.
The academic training program it operates through its affiliation with the Drexel University School of Medicine, which has one of the largest medical school class sizes in the country, is on pace to lose $30 million this year. The hospital is only getting about 7 percent of its admission from physicians who are also faculty members.
The vast majority of admissions are coming from patients coming into the emergency department who are on Medicaid or Medicare, which only pay a fraction of hospital charges. The high percentage of patients covered by government health insurance programs impacts the rate the hospitals gets for services provided by faculty physicians.
The lack of clinical documentation training for physicians that has resulted in a “tremendous volume” of downgrades and denials from insurers. Freedman estimated that between denials and admissions being downgraded to observation status the hospitals is probably being paid for 50 percent of the services it provides. "
It is pretty much as one has said, the HH is a charity/hospital of last resort that primarily serves Medicare/Medicaid population. No hospital today can survive on that sort of business model without huge infusions of cash from elsewhere.
Two, of the Medicare/Medicaid patients they do get charting/documentation isn't what it ought to be so HH isn't being paid fully of even the low Medicare/Medicaid reimbursement rates.
This has nothing to do with "Obamacare" per se; since obviously even those who now have insurance under that scheme aren't going to HH either in great numbers.
HH desperately needs (or rather needed) to attract a better patient mix, that is a larger share of patients with private insurance (and or who can self pay).
It is Saint Vincent's and countless other "chairty" hospitals all over again. Insurance companies were paying St. V less than Medicaid on average because the place had no leverage go get better reimbursement rates. That is what happens with all healthcare facilities who rely upon Medicare/Medicaid for large portion of their patients.
The famous/wealthy or whatever healthcare systems/hospitals in this country have high demand for their services. That in turn allows them to negotiate better rates from insurers or they will threaten to "prefer" patients with another carrier. This and via marketing along with a healthy dose of human behavior (when someone is ill in this country they tend to seek out the *best* they can get), famous or whatever hospitals have a demand you just don't see for charity/indigent places.
Places that provide large amounts of indigent care are called "hospitals of last resort" for a reason.
All hospitals will have different patient demographics and business. For instance one hospital might be able to accommodate more Medicaid patients if they have slack in their organization. A hospital may not actually sustain a loss by taking these patients. They might make less than private pay, but the Medicaid patients in total may help pay the overhead bills. It may be that a hospital may make more through Medicaid than without. Because without they may have to serve many more no payers. At least this was the scenario in AZ.
AZ's Medicaid plan is very different from the standard US model. It is a capitation plan administered by non-profits that compete for members and negotiate capitation (per head) payments to providers. It has been a boon to the health care industry in AZ which has been growing like crazy since Medicaid was expanded. It's not perfect, but it is a great model - better than Medicare for All IMO - to consider when looking at national health care options.
No, "we" aren't. I, for one, pay very little in health care costs. I have a low premium high deductible catastrophic policy and self-insure for routine medical care. I have no chronic illnesses and take no prescription meds. Spending $2,000/year, total, would be a lot for me.
You still pay for the uninsured, Medicare, and Medicaid which accounts for over 70% of healthcare costs.
Since no one needs the services of an ER ever, this is a really good idea.
I often wonder how that suggestion would work, precisely don't treat those that cant pay, Would people need to keep money in an escrow account that hospitals and medical professional has insight to? And would doctors be allowed to estimate what the total end price of care be and if their estimate exceeded that they they could refuse to treat. For instance, if someone comes into an E/R with chest pains, could a doctor assume it might be a heat attack that could require surgery and a multiple night hospital stay. And that estimate exceeds the 100k the guy has in escrow so they don't operate? Or would they proceed until funds were exhausted. So perhaps they have the surgery but then kick the guy to the curb because he cannot afford the overnight stay. Rid home or not. And what about ambulance rides. Do they leave you on the side of the road dying if they cannot verify funding?
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