Helping Those Most in Need

Imagine you are starting your career and the opportunity to work at one of the more prestigious, resource-rich care institu? tions in the country. Funding is readily available for new or expanded services, regular staff raises and promotions, experiments in delivery system changes, and creative recruit? ment and retention programs designed to attract the best and brightest in all clinical and non-clinical professions, not to mention lucrative executive incentive structures. Not too far away, however, are several other hospitals whose history, location, and past decisions (like choosing to stay in their respective communities and not move when population shifts occurred) left them with few, if any, of the paying patients who frequent hospitals like yours. Furthermore, these other hospitals cannot afford the special capital items you take for granted, like electronic medical records, integrated clinical-financial information sys? tems, and state-of-the-art diagnostic and therapeutic equipment. Moreover, although your have hospital contends that it pro? vides its fair share of uncompensated care, the fact is that these other facilities are carrying most of the economic burden of increasing amounts of charity care and bad debt. The patients of these hospitals delay treatment; use the emergency department for what primary care they can obtain; and do not access to a regular source of care, as no distributed primary care system exists. Even beyond that, state-based payment sys? tems continued to underfund sponsored and unsponsored patients alike, thereby causing the gap between reimbursement and actual cost to increase dramatically. What's the problem? The market, as it is wont to do, has determined the winners and losers, the rich and the poor, the haves and have-nots. In too many places across our country, situations like this increased the gap between resource-rich and resource-deplet? ed hospitals. The communities served by the latter group (what we like to call safety-net hospitals) tend to house those at the lower end of the socioeconomic scale. They live in health care and food deserts, and their populations typically the lowest and functional status in their metropolitan areas. What are we to do? Allow the market to determine who lives or dies?in terms of both organizations and people?or act to head off or at least minimize this ever-increasing gap? On the other hand, whoever said that it is the responsibility of thriving hospitals to solve the problems of failing institutions, even if they are neighbors? Is this not a chronic problem of continuous government non-involvement in the growing uninsured problem, whereby most state governments more or less force those hospitals that are most in need to continue to provide most of the care for those patients who are most in need? Years with lack of adequate payment combined with population shifts fueled by?

Abstract licence: CC BY-NC

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