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The price of helping the poor: Catholic hospitals suffer cuts, closure.

Catholic hospitals suffer cuts, closure, financial study says

WASHINGTON -- The more care that hospitals provide for the poor, the greater the probability that financial stress will close their doors, according to Edwin Fonner Jr., research director for the St. Louis-based Catholic Health Association of the United States.

Citing a study of the financial health of Catholic hospitals, Fonner said that those institutions serving the poor became significantly weaker financially during the 1980s.

The study, A Profile of the Catholic Health Care Ministry, 1992, found that the number of U.S. Catholic hospitals fell from 636 in 1982 to 594 in May 1992. Twelve more hospitals have closed since those figures were published, Fonner said.

The chief culprit of decline identified in the report was a Medicaid reimbursement policy that requires hospitals to accept less than their own costs for health care services provided to the poor.

Financiall strong hospitals with a high percentage of privatel insured patients can transfer some of their Medicaid losses to other patients, Fonner said, but institutions with mostly Medicaid patients cannot.

Consequently, high concentrations of poor people with serious health and social problems, coupled with inadequate Medicare reimbursement and growing Medicaid patient loads, adversely affect the financial viability of many Catholic hospitals, the report said.

Hospitals judged financially sound devoted an average of 10.7 percent of their gross patient revenue to care for the poor, the report said. For those in financial decline, that figure was 16 percent.

The CHA report also found that higher unemployment rates, lower per capita income and greater proportions of people living below the poverty line characterize the communities where Catholic hospitals suffered below-average financial performances from 1988 to 1990. More than two dozen communities across the nation contain a Catholic hospital that serves a population of whch 35 percent or more live in poverty.

As the numbers of poor and medically indigent grow, stresed hospitals may be be forced to restrict the number of poor and Medicaid recipient they admit -- or they may have to close their doors altogether, said the report.

St. Anne's Hospital shut down in 1988 after 85 years of service to Chicago's West Side. Hospital official said the health care facility suffered late and inadequate federal reimbursements for its services to poor patients. About 80 percent of St. Anne's patients were Medicaid or Medicare subscribers.

For many residents of East St. Louis, Ill., St. Mary's Hospital is the only source of critical health services available. Ninety-five percent of its population is African-American. More than half are younger than 19 or older than 64. Medicaid patients make up 48 percent of St. Mary's admissions.

The hospital lost $6.4 million in fiscal year 1990, but state reimbursement programs for indigent care helped cut losses to $1.1 million in fiscal 1991. However, without legislation that would guarantee long-term improvement in reimbursement, the hospital's future is questionable.

Catholic association takes health-care plan to capital

WASHINGTON -- The Catholic Health Association provided its vision of a redesigned health-care system March 29 during a public meeting of the President's Health Care Task Force.

"Reform must address the three pillars on which the American health care system is built: namely, access, quality and cost control" said Daughters of Charity Sister Bernice Coreil, chairwoman of the CHA Leadership Task Force on National Health Policy Reform.

"In developing a comprehensive benefit package to meet the health care needs, the president's task force should avoid creating a basic benefit package and that becomes a floor for the middle class and a ceiling for the poor," said Coreil.

CHA advocates a plan for an Intergreated Delivery Network in which care-givers would be organized to provide coordinated, comprehensive cradle-to-grave health care services. These networks would receive risk-adjusted payments and would be held accountable for improving or maintaining the health status of their enrolled populations.

Responding to the Clinton administration's goal of controlling health care costs, Coreil said, "The CHA reform proposal calls for a national global budget" and incentives aimed at encouraging "primary and preventive care, services in optimal settings, a more rational use of technology and accountability for improved health status."

CHA's proposal, Setting Relationship Right, focuses primarily on the needs and preferences of patients. "As health care leaders," said Coreil, "we can force the aspirin from $5 down to a nickel. But if all we do is achieve cost conntrol, without delivery reform, I fear we will have failed our fellow citizens."

Meanwhile, a coalition of labor, consumer and religious and other groups presented more than a million postcards and letters to Vice President Al Gore calling for a single-payer national health insurance program similar to Canada's.

"One million signatures for single-payer health insurance surely beats anything we've seen for so-called managed competition," said Senator Paul Wellstone (D-Minn.) at a rally near the White House before the meeting in late March with Gore.

Under a single-payer plan, health care consumers would receive cards to present to the providers of their choice. Except for perhaps a minimal, cost-sharing fee such as $5 for each visit to a doctor, the patient would see no bill; it would be paid through taxes.

Wellstone is part of a group of senators who recently introduced in the Senate the American Health Security bill which, among other things, envisions health insurance as a right, not tied to employment.

Said Wellstone, "It is our role to tell Hillary Rodham Clinton: Don't be incremental -- be bold"
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Title Annotation:includes related article on Catholic reform lobbying
Author:Vidulich, Dorothy
Publication:National Catholic Reporter
Date:Apr 9, 1993
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