Access:

The Orlando Regional Chamber recently presented the findings of it’s October, 2002Regional Leadership Survey.  In the survey, more than 1,000 registered voters were asked what should be our regional priorities.  Almost 75 percent (74.7) indicated that access to healthcare should be a high or very high priority.  Interestingly, this ranking was behind “good schools” (75.7%), but ahead of “reduced traffic congestion” (57.1%).  What is the real concern regarding access to healthcare? 

In the U.S., we have a growing physician shortage.  The American Medical Association estimates that there will be a deficit of 50,000 physicians by 2010 and a shortage of more than 200,000 by 2020. 

The CEO of a large regional healthcare system once said that he does not need statistics, studies or surveys to determine if there is a physician shortage in the community.  All he needs to know is the answer to one question.  “Are specialty physicians in the community willing to take an emergency room call?”  Doctors who are willing to take emergency room calls are typically looking to build their practice. If the answer to the question is “NO,” there is a physician shortage because it means all the practices are full. In Central Florida, more and more physician specialty groups are unwilling to take emergency calls without remuneration. 

Have you tried to make an appointment with your doctor recently?  You probably had to wait several days -- at least -- to get an appointment, right?  Not surprising.  Ask any physician and they will tell you that thanks to Medicare and other insurers driving down costs for office visits, they need to see 2 – 3 times the number of patients as they did five years ago just to generate the same revenue. 

When you need urgent attention, and cannot ‘access’ your doctor, you try to ‘access’ the emergency room.  Been there lately?  The area’s Emergency Medical Services systems track the time it takes for ambulance patients to be seen in the ERs.  As of November, 2002, the average time it takes for an ambulance patient to be seen in the ER is over 90 minutes.  You can imagine the time it takes a ‘walk-in’ patient.  Admittedly, if the patient is critical, they will typically been seen by the ER staff as soon as possible.  The problem is that 84.5 percent of the people visiting the ER are there for routine medical problems, many of them from the ranks of the region’s 562,000 uninsured population.

The Uninsured:

Much has been written about the crisis of the uninsured in America.  The most recent census data reveals there are more than 562,000 uninsured residents in Central Florida.  The reasons are numerous and have been exacerbated post September 11^th. 

The real problem with the uninsured is that those of us with insurance are paying for those without in the form of cost-shifting by the providers.  One of the reasons health insurance costs are rising so rapidly is the impact of this cost shift.  It has been described as a “vicious cycle.”  High provider costs of uncompensated, free care is passed on to those who do pay (insurance companies).  This higher cost is passed on to the premium payers in the form of higher premiums.  Facing higher premiums, employers or employees drop coverage, becoming uninsured.  They themselves then become uninsured and perpetuate the problem.

The uninsured issue is not a low-income problem.  According to recently released Census Bureau figures, 1.4 million additional Americans lost their health insurance last year, an increase largely attributed to the economic slowdown and resulting rise in unemployment. 

The largest group of the newly uninsured — some 800,000 people — had incomes in excess of $75,000. They either lost their jobs or were priced out of the health care market by rapidly rising insurance premiums.

In a New York Times article published on December 9, 2002, worried insurance executives across the country are pressing for new steps toward universal health care.  They are concerned that the growing number of uninsured patients will undermine the nation's health care system.  Executives at Blue Cross Blue Shield of Montana are pressing state legislators to raise the cigarette tax to subsidize basic coverage. Another insurer, Blue Shield of California, proposed a plan this week for health insurance for all state residents. And Dr. William W. McGuire, chief executive of the UnitedHealth Group, the largest private insurer, has written to every member of Congress calling for "essential health care for all Americans."

Malpractice Insurance:

In mid-November, the National Academy of Sciences released a comprehensive report on the state of our nation’s healthcare system.  In the area of malpractice, the report states: "For the first time in nearly 20 years, the United States is facing a broad-based crisis in the availability and affordability of malpractice liability insurance for physicians, hospitals and other health care providers." For some doctors in some states, it said, liability insurance has become prohibitively expensive, and the market for such insurance has become extremely volatile.

The malpractice issue is also serving to raise the cost of healthcare in general.  Fear of lawsuits drives doctors to limit what they do, and in some cases to order unneeded tests.  But are the insurance companies to blame?  According to Sam Miller, a spokesperson for he Florida Insurance Council, the answer is no. 

"Last year we paid out $1.36 for every dollar in premium we collected," Miller said. "Every year for the last five years we have paid out more in claims than the premiums we've collected. What's driving the rates is the total amount of money we're paying out, and the vast majority of that is lawsuit driven."

Consumers Union has suggested one proposal for a fix to this ailment.  Under the proposal, states could limit payments for pain and suffering and other non-economic damages.  The federal government would subsidize insurance for health care providers who promptly compensate patients for "avoidable injuries."  Alternatively, state agencies could adjudicate claims and decide the proper compensation, using a schedule of damages or other benchmarks.

Cost:

It has been widely reported that employers and individuals are facing skyrocketing costs for healthcare insurance.  According to a survey released this month by Mercer Human Resource Consulting, an employee-benefits consulting firm, employers expect healthcare costs to rise 14.6 percent in 2003, about the same as this year's 14.7 percent increase -- the steepest in a dozen years -- and seven times the rate of inflation.

In Central Florida, more and more businesses are unable to offer insurance to their employees.  The Employee Benefit Research Institute reports the 50 percent of businesses with fewer that 10 employees do not offer health insurance.  The Economic Development Commission of Mid-Florida indicates there are 70,000 businesses in Central Florida with fewer that 10 employees.  The Congressional Budget Office reports that for each 1 percent increase in the cost of health insurance, 300,000 people become uninsured.  So, are the increases really adding to the bottom line if they result in higher rates of uncompensated care and higher premiums??

How often do we have to hear that our healthcare system is a train heading for a brick wall before someone actually takes some initiative to switch tracks?  If you get on the wrong train, every stop along the way will be the wrong stop.

We have the capability for change.  We just need the vision and direction.

So what’s the bottom line?  Leadership!  In Congress, the White House, Tallahassee and regionally.  It’s true that we can’t solve problems with the same mentality that created them. 

You may contact Matt Zavadsky at (386)740-5201 or via email at mzavadsky@co.volusia.fl.us.