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Editorial: One more sign of a broken health system

In yet another disturbing sign that America’s health care system is broken, the urgent-care centers operated by Manchester’s Elliot Hospital now require a $150 advance payment before treating patients who lack health insurance and whose medical problem isn’t an emergency. Patients with insurance must hand over their co-pay up front.

The “pay-first” rule is becoming more common as hospitals struggle to reduce losses from uncompensated care and offset low payments by Medicaid and Medicare. Charging in advance may be good for a hospital’s bottom line, but it shifts costs to institutions that don’t require pre-payment – Catholic Medical Center in Manchester, for example, or community health centers. It also means that some people will go without care. When they do, the medical problems of some of them will worsen and require expensive emergency room treatment or hospitalization.

Federal law requires that hospital emergency departments assess the condition of every person who requests care and provide enough treatment to stabilize the patient. Hospitals and clinics are not, however, required to provide treatment for medical problems that are not an emergency – a sprained ankle or bad cold, for example. They’re free to tell those people, if they can’t pay, to seek care elsewhere.

It’s not hard to understand why Elliot Hospital adopted its new policy. Its losses from uncompensated care are growing rapidly, swollen in part by the growing percentage of insurance coverage that comes with co- payments bigger than many can pay. Elliot lost millions more when the state cut its payments to hospitals that care for a disproportionate share of patients on Medicaid. Its fee policy, however, is a Band-Aid on a bullet wound, and it’s dangerous. Emergency rooms and urgent care centers that turn away people who can’t pay gamble that the person’s problem was correctly diagnosed as one not threatening to life or limb. A misdiagnosis could mean a fine and a lawsuit.

If other hospitals and clinics emulate Elliot and adopt a pay-at-the-door policy, the waiting rooms of the state’s public health centers will be standing room only. To prevent a proliferation of up-front fees and other measures that make it more difficult for the uninsured to receive care, the governor and Legislature should accept the federal offer to expand Medicaid to cover tens of thousands of additional New Hampshire residents. Medicaid doesn’t pay providers well, but it pays. The state should also partner with the federal government to create a health care exchange, which will give people who aren’t poor enough to be covered by Medicaid a way to purchase coverage with the aid of a federal subsidy. Doing so will reduce the rolls of the uninsured and take some of the financial pressure off hospitals.

As for urgent-care centers, they play an important role in the delivery of health care and they reduce costs when they keep people with minor problems out of hospital emergency rooms. But they are no substitute for a primary care doctor, preventive health services and follow-ups. Neither are the “Doc in a Box” walk-in clinics that Walmart an other retailers have begun opening, nor the for-profit urgent care centers like the one slated to open on Loudon Road in Concord.

To control health-care costs and create a healthy populace, everyone should have health insurance and a medical home, a place whose staff’s first order of business is to keep their patients healthy and to treat them when they’re not. Up-front clinic and hospital fees and urgent-care centers that aren’t true medical homes aren’t the answer. They should go the way of the cassette tape and the floppy disk, only faster.

Legacy Comments8

1st: I don't want my money insuring illegal imigrants They are a drain on the system 2nd: This is going to cost ALL of us a lot more money. Those that are working will pay more to cover those that don't work. Those that don't work will still have to carry insurance or pay a fine. If they can't afford Ins how will they afford to pay the fine. They will still go to the hospital uninsured, and the cost will pass down to the rest of us. 3rd: this is a disaster waiting to happen. everything looks fine right now. Preexisting condition and 26 yr old are covered. Wait until this thing kicks into full gear. $$$$$$$$$$$$$$$. 4th: taxes going up for those making $250k or higher.. try for ALL of us. 5th: Hope you are happy, too late, you have this clown for 4 more years

I'm sure it had nothing to do with the huge new facility they just built! Concord Hospital will be doing the same at some point, given the constant construction they've had for the past 20 years. National health care IS used in Europe, and it's not anything we should copy. Should we use Greece as an example? If people had jobs, they could afford insurance and they could afford to go to the regular dr instead of using the ER. If people would stop overeating and smoking, everyone would be healthier. It's not the government's job to make sure we're healthy - it's our own.

"If people had jobs, they could afford insurance" Then wouldn't it be great if we could figure out how to have more jobs here, rather than outsourcing them to China where everyone has health insurance at no cost to employers?

Why don't Republican lawmakers want to fix this by covering every citizen with national health care, like the rest of the civilized world does? This US health care mess is also a major cause of job outsourcing. Maybe the Republican lawmakers haven't noticed that US employers are outsourcing our jobs to China, where their simpler and less costly national health care system, paid for through individual income taxes and a sales tax, doesn't red tape employers with employee health insurance, Medicare, and Medicaid costs.

You ask why? Because the government in charge of anything means several things.....rationing, poor administration, restrictive rules, red tape and most of us do not want some faceless government bureaucrat to decide when to pull the plug or put us on pain killers rather than treat us with some new therapy. US employers are outsourcing jobs to China because of excessive regulations, attempt of the government to exercise control over businesses and one of the highest corporate tax rates in the world. How many taxes are enough for you progressives? If you had your way the government would confiscate all checks and give us a stipend to live on. The rest of the world with universal health care are primarily socialist democracies and the systems ration, fail, determine when you have had enough treatment, make end of life decisions, pay for euthanasia, abortions, etc. You would trade freedom for a bit of comfort rather than tough it out. So sorry, we don't want your lousy government run anything.

Sure - should we follow the broke Greek system where they're calling for reform, or the one in France or Spain where high costs are out of control, or the British system with rationing ???

So we don't ration health care here? What about the millions of uninsured Americans who find that "Hospitals and clinics are not...required to provide treatment for medical problems that are not an emergency....They’re free to tell those people, if they can’t pay, to seek care elsewhere." We have about the same debt per capita as Greece, so maybe our system is just as broke as "the broke Greek system". I wonder if the Greeks have been rationing their jobs too, like we have been doing, in no small part because Chinese employers don't pay for health care insurance, Medicare taxes, and Medicaid taxes, like our employers do.

Please seek guidance. Not everthing is the fault of Republicans, the Tea Party, Koch Brothers, Reagan, Bush, Gingrich, etc. In fact, most everything is the fault of progressives!

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