COVID has brought to light the disparities in American healthcare and how the pandemic has hit hospitals hard. Among these hospitals are the so-called safety-net hospitals (SNHs), whose mission is to serve working-class, low-income and poor urban communities. Though extremely overwhelmed by the current global health crisis, SNHs have sadly already been on the brink of collapse even before the pandemic began.
In recent years, the healthcare industry has experienced a seismic shift from saving lives - to earning money. Market forces and uneven government support have resulted in certain hospitals seeing profits soar while other facilities struggle to stay afloat. Dr. Bruce Siegel, president of America's Essential Hospitals and healthcare policymaker, believes that it will only get worse for many of these safety-net facilities with the ongoing pandemic.
The current state of American healthcare can trace its beginnings to about 50 years ago, when the first for-profit hospitals (FPHs) opened to the public in Nashville, Tennessee.
Owned by corporations, these hospitals provided quality care, but the main objective was to make money. New hospitals were built to compete with those already in the community (compete for staff, government support and supplier discounts) and then only accept patients that can pay or have health insurance to maximize earnings.
Over time, FPHs have become more prominent and more successful because their clients have health insurance or can afford to pay. SNHs, on the other hand, do not have customers who can pay for services. Being in low-income communities, they don't focus on the more profitable medical services. They also depend on Medicaid reimbursements and supplemental government payments.
Medicaid is governmental health coverage assistance for very low income individuals. On the other hand, supplemental payments are additional funds - also from the government - to help non-profit hospitals recover from Medicaid-related losses.
Sadly though, Medicaid payments to SNHs are inexplicably small, while the government supplemental payment allowance has also shrunk considerably. These circumstances have resulted in rich hospitals getting richer while poor hospitals getting poorer. And because they are in such dire shape, some SNHs have decided to take drastic measures.
The story of safety-net hospital Erlanger in Chattanooga, Tennessee, is one such cautionary tale. After years of incurring losses, they decided to pivot and focus on more profitable healthcare services. However, despite channeling millions of dollars in upgrades, as recently as late 2019, the staff is shorthanded and the hallways are teeming with patients waiting to be seen.
It was clear that spending all those funds to gain market share, to increase volume, and attract paying patients did not guarantee quality care. This growing divide in healthcare represents the larger societal inequalities brought about by the failure in social policy and politics that is currently taking place in America today. Providing sustainable quality healthcare for any nation is an important yet challenging issue that governments must address sooner rather than later.
Directed by: Rick Young