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An urban hospital in Columbus announces it will close its emergency room, which had 20,000 visits per year, without consulting the emergency medical system... A for-profit "boutique" (specialty) heart hospital is constructed in Dayton despite expert testimony at public hearings showing the damaging impact this will have on existing hospitals. Within two years, a safety-net hospital near the heart hospital closes. What's wrong with this picture? Until recently nine area Health Systems Agencies engaged in regional planning, bringing local input from consumers, providers, insurers, and government agencies. But the current state budget eliminated funding for the HSAs leaving no money to operate. "It seems ironic. Area-wide planning is ending at a time when there is an increase in the number of indigent and uninsured patients, fewer facilities because of the closure of Columbus Community Hospital and other facilities, uncertain financial futures at many hospitals and escalating medical costs. There seems to be a greater need than ever for health planning, monitoring and coordination of services," noted Richard L. Sims, president of the Scioto Valley Health Systems Agency, which covered Franklin and 15 other surrounding Ohio counties. The HSAs were put in place by state law in the 1970s to plan and monitor health facilities and services and to promote health improvement. The HSAs were by no means, perfect, but they did provide a public process for considering community health needs. However, in 1995, the Ohio Legislature eliminated the requirement for hospitals to obtain a certificate of need from the local HSA before making major construction or purchase decisions. With this oversight gone, the "marketplace" took over. In other words, opponents of CON believed that consumers, through their spending, would determine what hospitals and services are needed. Problem: Health is not a "market" commodity. Unlike fast food or clothing stores, hospitals give care to uninsured people (11percent of Ohioans) regardless of their ability to pay. Hospitals operate emergency rooms and burn units, even when those services don't turn a profit. Yet, in this era of deregulation and "market medicine," human needs now take a back seat to market share and profit margins. Hospitals must compete successfully for paying patients, with each other and with for-profit specialty centers. Fact: In Columbus, all 3 adult hospital systems are building multi-million dollar heart facilities, despite no determination of community need. Fact: There are only two gamma knife facilities in Ohio (for sophisticated brain surgery) and in the name of competition they are within walking distance of each other. "As competition replaces regulation in health care, existing organizations as well as new ones are positioning themselves to compete successfully for paying patients," according to a 2000 study by the HSAs. So, who is worried about the uninsured, who keep losing safety-net hospitals in underserved communities. Another recent scenario provides a graphic example of need vs. greed in the area of deregulation: an inner city nursing home wanted to move its beds to an outer ring suburb. This nursing home transfer still does require a certificate of need to make sure beds remain where they are needed. When the local HSA denied the move based on community need, the nursing home operator and lobbyists convinced the state to overturn the decision. Conclusion: Though there may have been flaws-, inefficiencies, and inconsistencies in the Certificate of Need process, the HSAs provided a viable connection between the "players" (including consumers) and the overall health system. Nothing has replaced this connection. With no protections, Ohioans are at the mercy of whoever has the money/power at the moment. Just ask the folks at Mt. Sinai, Columbus Community, Doctors North, St. Luke's, etc. Solution: Ohio needs a public regulatory system with teeth and independence from special interests. The public agency must put the public's health and welfare above all other considerations. The system must assume the data collection role of the HSAs, to track changes in access, cost and quality of health care brought about by deregulation. It needs to be responsive to all local interests and regional in its outlook. Will policymakers with vision create such a regulatory agency before our health care system is irrevocably damaged? Diane Lardie is the executive director of national UHCAN!; Cathy Levine is policy director of UHCAN Ohio.
The following are some of the services lost by the legislators' decision to eliminate funding for the Health Systems Agencies: All HSAs established area resource monitoring systems and developed comprehensive health resources plans with annual updates. The Akron area HSA led the way in sensitizing the state to the need to monitor hospital not-for-profit to for-profit conversions. The Cincinnati area HSAs 1996 health status mapping study led to the formation of the Central Ohio River Valley Cancer Alliance. The Cleveland area HSA established a Regional Health Information Center, which included an interactive Web Site to provide community data to help consumers make their health care decisions about physicians and health plans. The Columbus area HSA established a cataloging system for all health care needs assessments being performed in its area. The Dayton area HSA implemented the only regional youth anti-tobacco initiative in the nation in 1998, according to the Center for Disease control. The Toledo area HSA demonstrated the health status issues with five-year trends of causes of death, disease and incidence--and encouraged the community to develop responses to these identified issues. The Youngstown area HSA prepared special reports on infant mortality, low birth weight and prenatal care.
Hold Candidates Accountable on Health Care Issues In Cleveland there is currently a closely contested race for mayor of the city. The major issues discussed revolve around safety, education, and development. By and large, health issues were not included. Recognizing this, UHCAN Ohio, working together with the Community Partners for Affordable Accessible Health Care, a coalition of 27 community groups, developed a health care platform. Candidates were asked to respond to a 12-point platform which included: keeping all city-owned clinics open and fully staffed; linking city assistance to hospitals and other health care providers with their expansion of primary health care services to vulnerable residents; and committing to work with the county to achieve local systemic reform toward universal access to care. (The full platform and responses by the mayoral candidates can be found on our web site at www.uhcanohio.org). Candidates' responses have been positive. The platform has forced them to give serious consideration to the health issues of Cleveland, and their responses in support of the platform will serve as a strong foundation for holding the next mayor of Cleveland accountable for improving health care access and public health services in the city. Elections for state and county offices, including the governor and county commissioners, take place next year. Generally, health care issues have not played a prominent role in these elections. We can change that. We can take advantage of the election process to get commitments from county commissioner candidates to actively work for health care expansion efforts, and to agree to link tax-exempt hospital bond requests with community benefit requirements by the local hospitals. On a state level we can be seeking support from our governor and legislative candidates for expanded Medicaid coverage for parents, increased funding for our community health centers, and reinstatement of the health systems agencies. In the state of Ohio and in our communities where health care has taken a back seat to other issues in elections, we need to develop health care platforms, obtain unqualified commitments from electoral candidates in support of these platforms, and publicize the commitments and their health care positions. It's a way of holding our elected officials publicly accountable as we strive for health care for all Ohioans.
These hospitals have been closed without community input since the elimination of Ohio's certificate of need in 1995. Butler County Cuyahoga County Mt. Sinai Medical Center-University Circle Franklin County Columbus Community Hospital Hamilton County Jewish Hospital* Bethesda Oak Hospital Jackson County Lawrence County Lucas County Mahoning County Woodside Hospital (psychiatric) Youngstown Osteopathic Hospital Marion County Meigs County Miami County Montgomery County Franciscan Medical Center Richland County Richland Hospital (behavioral health and substance abuse) Scioto County Stark County Summit County Trumbull County Warren General Hospital
UHCAN Ohio has joined the Prescription Access Litigation project (PAL). Community Catalyst, a Boston based organization created the project to make prescription drugs more accessible to those who need them by undertaking class action suits against pharmaceutical companies that maintain excessively high prices for prescription drugs through various unfair and illegal practices. PAL is comprised of nearly 60 grassroots organizations in 25 states. Some of the member organizations are currently involved in one or more of three sets of lawsuits filed by PAL.
Approximately 40,000 people are uninsured in Lucas County. UHCAN Ohio's Toledo board members, Karen Krause, R.N., executive chairperson of NW Ohio UHCAN, and Johnathon Ross, M.D., Director of Outpatient Clinics at St. Vincent Mercy Hospital and president of national PNHP, are part of a public health initiative focused on solutions. Both are active in Access to Quality Health Services Work Group, a group of some 15-20 individual and organizational representatives from a variety of community organizations, the two major hospital systems, the local health department, and Neighborhood Health Association (the local community health centers network). Their mission is to assure access to health care for vulnerable persons in Lucas County.
Developing Meaningful Access to Health Care for Individuals
with Limited English Proficiency
Physicians and Charity Care
Health Care and Health Insurance Disparities Experienced
by Women
Mental Health Care Disparities Experienced by People of
Color
Employer Health Care Costs Climb 11 Percent For the first time since 1992, inflation for employer health care costs climbed into double digits, increasing 11 percent, "a sure sign that consumers would soon pay more for medical coverage," a survey by the Kaiser Family Foundation and the Health Research and Educational Trust. In 2001, workers paid 15 percent of the cost for single coverage, compared with 21percent in 1996 and 27 percent for family coverage in 2001, compared with 28 percent in 1996 (Snider, Bloomberg News/Arkansas Democrat-Gazette, 9/7). Sixty-four percent of employers said prescription drug costs contributed "a lot" to the increase in health plan premium costs (Washington Post, 9/7. Excerpted from American Health Line, September 9, 2001) Legislative Activity Targeting Rx Costs In 2001, 27 state legislatures, including Ohio, introduced bills modeled after Maine's successful legislation. Over 40 states are involved in providing a variety of solutions to the escalating costs of prescription drugs and the rising number of the uninsured. Among the proposals are supporting multi-state purchasing alliances, establishing Medicaid prices for seniors, creating or expanding pharmacy discount programs for seniors, and setting prices at the lowest market rate available (Center for Policy Alternatives, June 2001).
UHCAN Ohio keeps an eye on Ohio health legislation. House Bill 33 (Rep. Lynn Olman, R-Maumee), Equal Treatment
for Persons with mental health disorders.
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