Non-elderly Americans (65 and under) w/o health insurance increased 10% from 2000-2002 to over 44 million (17% of population)
Over 49,500 uninsured in St. Joseph County
Increases in uninsured have been linked to employers dropping health care coverage and increasing costs of health care coverage
The uninsured do not come from one social, economic, or racial class
They come from all walks of life
“ Cover the Uninsured Week” – report by Ann Thompson firstname.lastname@example.org
Uninsured of St. Joseph County “ Only questions with more than 50 respondents are included in the county profile, as a sample less than 50 would not provide statistically stable results. Due to the relatively small size of the SJC sample (236 respondents), analysis based on age, race and sex could not be completed”. http://www.stjosephcountyindiana.com/sjchd/PDFs/St.%20Joseph%20County%20Health%20Department%20-%20Health%20Assessment.pdf
Hoosier Healthwise SCHIP and Medicaid of Indiana
Who’s Eligible - “children, pregnant women, and low-income working families” – Must meet income requirements (150% of poverty level)
How do they receive health care? – Each family is assigned a PMP (primary medical physicians). The program provides you with a list of doctors to choose from in your area
- PMP must be picked within 30 days of beginning the program, and you must maintain a PMP for 12 months unless you supply “good cause”
- Choose a Managed Care Organization
- You can only receive care from within your MCO
http://www.in.gov/fssa/maternal/hoosier_healthwise/whoiselig.html http:// www.in.gov/fssa/maternal/hoosier_healthwise/getcare.html Interview with David Roos (Vice President St. Joseph County Health Department [email_address] )
Ex. Package A includes – hospital care, doctor visits, check ups, prescription drugs, lab services, substance abuse services, mental health care, dental care, vision care, transportation, chiropractors, etc. at NO COST
Package C offers the same services but with co-payments for prescription drugs and limited other services (151%-200% of the poverty level – not the poorest)
All payment goes directly to the health care providers and not to the families enrolled
-Pay premiums with SCHIP but not with Medicaid
http://www.in.gov/fssa/maternal/hoosier_healthwise/benefits.htm Interview with David Roos (Vice President St. Joseph County Health Department [email_address] ) l
Scoring hospitals on a set of weighted performance measures centered on clinical excellence, operating efficiency and financial health, and responsiveness to the community:
Risk-adjusted mortality index
Risk-adjusted complications index
Risk-adjusted patient safety index
Core Measures Score
Severity-adjusted average length of stay
Expense per adjusted discharge, case mix- and wage-adjusted
Profitability (operating profit margin)
Cash to total debt ratio
Growth in patient volume
100 Top Hospitals: National Benchmarks for Success — 2005
Allocation of Dollars and Persons Served under Adopted Charity Policy
Most nonprofit hospitals adopt a charity benefit policy to serve the medically indigent. On an annual basis, the hospital will confirm the eligibility and set aside dollars to ensure low-income persons can be offered needed inpatient and outpatient hospital services.
Allocation of Dollars and Persons Served under Adopted Charity Policy http://www.in.gov/isdh/regsvcs/acc/fiscal03/005053.pdf $1,939,266 $1,477,122 $1,406,977 Charity Care Allocation 2,799 2,181 2,321 Persons served in the last 12 months 2003 2002 2001
Unreimbursed Costs of Charity Care, Government Funded Programs, and Community Benefits
Based on uniform definitions of costs, each nonprofit hospital must identify the costs of serving its community that are not reimbursed by government and other third party payers.
($5,328,613) Total Costs of Providing Community Benefits ($1,196,700) Other Unreimbursed Costs ($1,743,845) Community Programs and Services 0 Community Health Education ($2,388,068) Total unreimbursed costs of providing care to patients unable to pay, to patients covered under government funded programs, and for medical education, training
Uncompensated Care http://www.qualityoflife.org/aboutus/publications.cfm 6.51% 5.47% 5.24% Percent of total 23,716 18,341 16,436 Provisions for bad debt $364,300 $335,189 $313,328 Net Patient service revenue 2005 2004 2003
“ We welcome any opportunity to help those without healthcare simply because they have no way of coming to us. I am proud to say that with the Mobile Medical Unit, we are coming to them.” Nancy Hellyer, St. Joseph’s Regional Medical Center Chief Executive Officer.
Dental clinic on site for general preventive and restorative dental care.
Any services that are necessary but not available because of a lack of equipment or any other reason at the Health Center are available at St. Joseph’s. Those such as eye specialists and ear nose and throat specialists are offered for free by the doctors of the St. Joseph Medical Center.
Patients are directed to St. Joseph’s Hospital for emergency care.
Hospital bill is forwarded to the Health Center. The case is reviewed and in most instances the bills are covered.
If a patient must be admitted:
-Financial Advisor helps the patient apply for HCI, a government program that will cover the cost of the stay.
-If not accepted by HCI, St. Joseph’s Regional Medical Center absorbs the cost of the stay.
Information provided in an interview with Lilia Periquet, Social Work Coordinator (4/3/07)
~University health insurance (Megalife) is only mandatory for graduate and international students (undergraduates do not need to provide proof of insurance, they only need to call in August to remove Megalife from their billing account). ~Students are not charged to been seen by professionals at the health center, but supplies, medicines, procedures, labs, and x-rays ~All charges except for lab and radiology are billed directly to Student Accounts, they do not file claims ~An itemized statement will be given to the student or sent through campus mail for them to file with their insurance if they are not a part of Megalife.
“ All Notre Dame students are invited to use our medical services regardless of having private, school sponsored insurance, or no insurance coverage.” Ann Elizabeth Kleva, RN, MSA, Director, University Health Care Services
The services listed below are the financial responsibilities of a patient:
• Laboratory tests
• Injections, including allergy shots
• Medical supplies
• Medical procedures
• Consultations with physicians outside University Health Center
• Hospitalization and / or treatment at a community hospital or emergency room
ND Health Services does not take care of payments for you
ND Health Services only takes Megalife Insurance
“ The only insurance that we take is the Notre Dame MegaLife Insurance, If you have private insurance, we will provide you with a detailed receipt for filing with your insurance company for reimbursement each time you receive a prescription. We can also provide a detailed statement upon request.”