Health care for the uninsured in St. Joseph's County


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Health care for the uninsured in St. Joseph's County

  1. 1. Health care for the uninsured in St. Joseph’s County Econ 30500 – Economics of Poverty Professor Warlick Claire Anderberg, Jaime Dennig, George Fisher, Eileen Offer, Oscar Padilla, Sharon Zhu
  2. 2. Objectives <ul><li>How do Indiana State programs help alleviate financial stresses? </li></ul><ul><li>Economic burden to Memorial Hospital </li></ul><ul><li>How are hospitals reaching out to the community? </li></ul><ul><li>Health care for extreme poverty </li></ul><ul><li>Health care on campus </li></ul>
  3. 3. Statistics <ul><li>Non-elderly Americans (65 and under) w/o health insurance increased 10% from 2000-2002 to over 44 million (17% of population) </li></ul><ul><li>Over 49,500 uninsured in St. Joseph County </li></ul><ul><ul><li>Increases in uninsured have been linked to employers dropping health care coverage and increasing costs of health care coverage </li></ul></ul><ul><li>The uninsured do not come from one social, economic, or racial class </li></ul><ul><ul><li>They come from all walks of life </li></ul></ul>“ Cover the Uninsured Week” – report by Ann Thompson
  4. 4. 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”.
  5. 5. Hoosier Healthwise
  6. 6. Assistance for low income families <ul><li>CKF ( Covering Kids and Families of St. Joseph County ) helps families in the process of applying for health care aid through “Hoosier Healthwise” </li></ul><ul><li>Goal of CFK is “to ensure that all eligible families have access to affordable healthcare” </li></ul><ul><li>There are many different places around South Bend that to go for help in enrolling for Hoosier Healthwise </li></ul>http://
  7. 7. Hoosier Healthwise SCHIP and Medicaid of Indiana <ul><li>Who’s Eligible - “children, pregnant women, and low-income working families” – Must meet income requirements (150% of poverty level) </li></ul><ul><li>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 </li></ul><ul><li>- 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” </li></ul><ul><li>- Choose a Managed Care Organization </li></ul><ul><li>- You can only receive care from within your MCO </li></ul> http:// Interview with David Roos (Vice President St. Joseph County Health Department [email_address] )
  8. 8. Benefits Covered <ul><li>- Emphasis on preventative care and check-ups </li></ul><ul><li>There are different packages available </li></ul><ul><ul><li>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 </li></ul></ul><ul><ul><li>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) </li></ul></ul><ul><ul><li>All payment goes directly to the health care providers and not to the families enrolled </li></ul></ul><ul><ul><li>-Pay premiums with SCHIP but not with Medicaid </li></ul></ul> Interview with David Roos (Vice President St. Joseph County Health Department [email_address] ) l
  9. 9. In case of an emergency… <ul><li>Participants in the Hoosier Healthwise system are told to contact their PMP first </li></ul><ul><li>If the doctor is not in but can speak with the patient, the doctor will further direct them </li></ul><ul><li>In the event of an immediate emergency they must go to the hospital and contact their PMP from the hospital </li></ul><ul><li>(the use of the PMP is to hopefully prevent emergencies by using preventative care) </li></ul>
  10. 10. Memorial Hospital <ul><li>Activity (1/1/2005–1/1/2006) </li></ul><ul><li>Admissions: </li></ul><ul><ul><li>18,158 </li></ul></ul><ul><li>Inpatient surgeries: </li></ul><ul><ul><li>4,912 </li></ul></ul><ul><li>Outpatient visits: </li></ul><ul><ul><li>157,043 </li></ul></ul><ul><li>Outpatient surgeries: </li></ul><ul><ul><li>8,720 </li></ul></ul><ul><li>Emergency room visits: </li></ul><ul><ul><li>48,527 </li></ul></ul><ul><li>Births: </li></ul><ul><ul><li>3,251 </li></ul></ul><ul><li>Number of beds: </li></ul><ul><ul><li>325 </li></ul></ul><ul><ul><ul><ul><li> </li></ul></ul></ul></ul>
  11. 11. Top 100 Hospital In U.S. in 2005 <ul><li>Methods </li></ul><ul><ul><li>Scoring hospitals on a set of weighted performance measures centered on clinical excellence, operating efficiency and financial health, and responsiveness to the community: </li></ul></ul><ul><ul><li>Risk-adjusted mortality index </li></ul></ul><ul><ul><li>Risk-adjusted complications index </li></ul></ul><ul><ul><li>Risk-adjusted patient safety index </li></ul></ul><ul><ul><li>Core Measures Score </li></ul></ul><ul><ul><li>Severity-adjusted average length of stay </li></ul></ul><ul><ul><li>Expense per adjusted discharge, case mix- and wage-adjusted </li></ul></ul><ul><ul><li>Profitability (operating profit margin) </li></ul></ul><ul><ul><li>Cash to total debt ratio </li></ul></ul><ul><ul><li>Growth in patient volume </li></ul></ul><ul><ul><ul><ul><ul><li>100 Top Hospitals: National Benchmarks for Success — 2005 </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li> </li></ul></ul></ul></ul></ul>
  12. 12. Allocation of Dollars and Persons Served under Adopted Charity Policy <ul><li>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. </li></ul>
  13. 13. Allocation of Dollars and Persons Served under Adopted Charity Policy $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
  14. 14. Unreimbursed Costs of Charity Care, Government Funded Programs, and Community Benefits <ul><li>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. </li></ul>
  15. 15. Specialized Programs Unreimbursed Costs <ul><ul><ul><li> </li></ul></ul></ul>($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
  16. 16. Uncompensated Care 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
  17. 17. Options for Uninsured- Underinsured <ul><li>Payment plans if possible. </li></ul><ul><ul><li>Collect as much as possible if continued procedures are needed. </li></ul></ul><ul><li>Discounts on procedures. </li></ul><ul><ul><li>Collect as much as possible all things considered. </li></ul></ul><ul><li>Refer to various help agencies. </li></ul><ul><ul><li>Religious groups, clinics, etc. </li></ul></ul>
  18. 18. St. Joseph’s Regional Medical Center <ul><li>Established in 1882 by the Sisters of Holy Cross </li></ul><ul><li>Center’s Mission: To serve together in Trinity Health in the spirit of the Gospel to heal body, mind and spirit to improve the health of our communities, and to steward the resources entrusted to us. </li></ul>
  19. 19. Outreach Programs <ul><li>Michelle Peters: Director of Outreach Services </li></ul><ul><li>Outreach Programs offer primary and educational services to community members in St. Joseph and Marshall Counties. </li></ul><ul><li>Established to serve the un-insured, under-insured and Medicaid populations in both counties. </li></ul>
  20. 20. St. Joseph’s County
  21. 21. Outreach Clinics/Services <ul><li>Sister Maura Brannick Health Center – South Bend </li></ul><ul><li>Healthy Family Center – Mishawaka </li></ul><ul><li>Family Medicine Center – South Bend </li></ul><ul><li>St. Joseph’s Urgent Care Center </li></ul><ul><li>Mobile Medical Unit </li></ul>
  22. 22. Mobile Medical Unit <ul><li>Established in December 2005 </li></ul><ul><li>40 Foot Long “Clinic on Wheels” </li></ul><ul><li>“ 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. </li></ul>
  23. 23. Mobile Medical Unit
  24. 24. Mobile Medical Unit <ul><li>Staffed by a Family Nurse Practitioner, mammographer, and intake coordinator. </li></ul><ul><li>Services Provided: Mammograms, physicals, women’s health, health screenings, minor illness, health maintenance </li></ul>
  25. 25. Mobile Medical Unit <ul><li>Areas the MMU Serves: </li></ul><ul><ul><li>West Side of South Bend (2 Days) </li></ul></ul><ul><ul><li>Mishawaka (1 Day) </li></ul></ul><ul><ul><li>Plymouth (2 Days) </li></ul></ul><ul><ul><li>Amish Country (Every 3 rd Friday) </li></ul></ul><ul><li>Schedule on the website shows where the MMU will be every day of the month: </li></ul><ul><ul><ul><li> </li></ul></ul></ul>
  26. 26. Problems with Outreach Services <ul><li>Struggle to spread awareness of these programs. </li></ul><ul><li>Trying to get more recognition out there so that the community knows that St. Joe is doing all of this. </li></ul><ul><li>Patients are missing their preventative care because they are unaware of these programs </li></ul>
  27. 27. Working Together <ul><li>St. Joseph’s and Memorial have begun collaborating their efforts through advertisements and funding </li></ul><ul><li>Local Businesses and Media are working to spread the word as well </li></ul>
  28. 28. What happens to a person who is unable to purchase medical insurance and is ineligible for Medicare or Medicaid? The Sister Maura Brannick Health Center Chapin Street, South Bend <ul><li>Sponsored by St. Joseph Regional Medical Center </li></ul><ul><li>60 Volunteer Doctors from the South Bend/Mishawaka Area </li></ul><ul><li>Multilingual Staff including Social Workers and Financial Counselors </li></ul><ul><li>Onsite Dental Clinic </li></ul><ul><li>$5 Co-pay covering all services and medication </li></ul>
  29. 29. <ul><li>To become a patient: </li></ul><ul><li>Application involving financial screening </li></ul><ul><li>Necessary criteria: </li></ul><ul><li>-Ineligible for Medicaid or Medicare </li></ul><ul><li>-Unable to obtain health insurance </li></ul><ul><li>-Must be 150% below the government established poverty line. </li></ul><ul><li>-Can not be a patient at another clinic </li></ul><ul><li>All patients are assigned a primary care doctor. </li></ul>
  30. 30. <ul><li>Services at the Health Center </li></ul><ul><li>Preventive healthcare. </li></ul><ul><li>Treatment for acute injuries or illness. </li></ul><ul><li>Chronic disease management. </li></ul><ul><li>Screenings. </li></ul><ul><li>Free immunizations for those who qualify. </li></ul><ul><li>Head Start and school physicals. </li></ul><ul><li>Prenatal and OB care. </li></ul><ul><li>Drug Assistance Program w/pharmacist available. </li></ul><ul><li>Nutritional and diabetic counseling. </li></ul><ul><li>Dental clinic on site for general preventive and restorative dental care. </li></ul><ul><li>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. </li></ul>
  31. 31. What happens in the case of an emergency? <ul><li>Patients are directed to St. Joseph’s Hospital for emergency care. </li></ul><ul><li>Hospital bill is forwarded to the Health Center. The case is reviewed and in most instances the bills are covered. </li></ul><ul><li>If a patient must be admitted: </li></ul><ul><li>-Financial Advisor helps the patient apply for HCI, a government program that will cover the cost of the stay. </li></ul><ul><li>-If not accepted by HCI, St. Joseph’s Regional Medical Center absorbs the cost of the stay. </li></ul><ul><li>Information provided in an interview with Lilia Periquet, Social Work Coordinator (4/3/07) </li></ul><ul><li> </li></ul>
  32. 32. ~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.
  33. 33. <ul><li>“ 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 </li></ul>
  34. 34. <ul><li>The services listed below are the financial responsibilities of a patient: </li></ul><ul><li>• Laboratory tests </li></ul><ul><li>• X-rays </li></ul><ul><li>• Injections, including allergy shots </li></ul><ul><li>• Medications </li></ul><ul><li>• Medical supplies </li></ul><ul><li>• Medical procedures </li></ul><ul><li>• Consultations with physicians outside University Health Center </li></ul><ul><li>• Hospitalization and / or treatment at a community hospital or emergency room </li></ul>ND Health Services does not take care of payments for you
  35. 35. ND Health Services only takes Megalife Insurance <ul><li>“ 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.” </li></ul>
  36. 36. Options for Payment <ul><li>Deferred payment </li></ul><ul><li>Payment in installments </li></ul><ul><li>Rector funds (on a case by case basis) </li></ul>
  37. 37. Who is Uninsured? <ul><li>Not always what you expect </li></ul><ul><li>Small Business owners </li></ul><ul><li>Transitional workers </li></ul><ul><li>Divorced individuals </li></ul><ul><li>Single working males </li></ul><ul><li>Notre Dame students </li></ul><ul><li>College Graduates </li></ul><ul><li>This is not just a problem contained by a certain socioeconomic stratum, it encompasses people from all walks of life. </li></ul>