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Goal #4: Provide First-Class Access to Health Care
Our uninsured patients deserve first-class access to health care services in their local communities.
The Problem
In 2006, Louisiana was rated the least healthy state in America, and approximately one in five adults is uninsured – among the highest rates in the nation. Our unique
health care model funds 10 state-run hospitals that are primarily responsible for delivering health care for the uninsured and operate alongside a system for patients
with private insurance and Medicaid or Medicare. The Louisiana tradition of caring for the uninsured through the charity hospital “safety net” has proven
enormously expensive, yet provided inadequate access to care.
The Solution
All of our patients, insured and uninsured, deserve a health care system that meets their needs. In step with every other state in the country, it is time for
Louisiana to embark on the path toward a single, competitive health care system that is more efficient, cost-effective, and better meets the needs of all patients.
Responsibility for providing care to the uninsured should be shared by the private and public sectors, with an emphasis on local governance, allowing LSU to
focus on world-class medical education and research.
The healthcare system in Louisiana is distinguished
by its determination to assure a safety-net of
care to its most needy citizens.
What has evolved is a polarized state healthcare system…[
that] is not good for the healthcare of
all Louisianans.
– PriceWaterhouseCoopers, 2006
The Blueprint for Action
- Redirect state funds from facilities to people. Funding for the uninsured is formally known as Disproportionate Share Hospital (DSH) payments. At a cost of
nearly $1 billion per year, Louisiana directs most of these resources to state-run charity hospitals. To provide patients with a choice in health care, the state should
reallocate some of these funds to a variety of qualified providers – public or private hospitals,
clinics, or doctors. In this way, dollars can “follow the patient” to their local choice for
preventive and primary health care. This approach will emphasize early diagnosis and
treatment to avoid expensive hospitalization and specialty care. Experts contend that
this shift will lead to millions in annual savings over time.
Investment in our future: $40 million savings – combined figure for steps #1 and #2
- Allow LSU to focus on high-quality medical education and research. Since 1997, LSU has held a dual mission to run the state’s charity hospital system and
educate medical professionals, which can lead to a lack of focused attention in either area. The legislature should focus LSU’s mandate to providing medical education,
conducting research, and offering specialized patient care in no more than four academic medical centers.
LSU-run academic hospitals should expand their patient mix to include private insurance and Medicaid patients. Similar to private hospitals, they must be able to generate
revenue, be held accountable for their performance, and be viable over time. To help make this possible, the legislature should approve funds to update and construct new
facilities that are appropriate to address market demand, the needs of the uninsured, and concerns related to health worker shortages.
Investment in our future: $40 million savings – combined figure for steps #1 and #2
- Customize care for the uninsured at the regional level. Local communities should determine the future of
uninsured care in their area.
In fact, local leaders and health care providers in some parishes are already developing plans to this effect. The
legislature should authorize the Department of Health and Hospitals to work with regional task forces of stakeholders
and the public to jointly determine health care needs and options.
Future plans might include local governance of
the charity hospital, conversion from an inpatient facility to outpatient clinics, or an entirely new system to increase
primary and preventive care. The decision would be made at the local level with legislative approval.
Investment in our future: $6 million
- Expand coverage for low-income parents. Louisiana has excelled at enrolling eligible children in insurance programs
in recent years. However, this success does not hold true for their parents and other low-income adults. Due to severely
low eligibility requirements to qualify for current programs, our state has the second-lowest percentage of adults receiving
Medicaid benefits in the country. In an effort to reduce the number of uninsured citizens in Louisiana, the state should raise eligibility limits to include 100,000 parents,
which would “influence their own health and access to care, as well as the well-being of their families.” Although a significant cost is entailed, this will leverage federal
funds and reduce the number of uninsured in our state.
Investment in our future: $94.1 million
- Maximize existing federal funds for medical education. Because LSU trains physicians primarily in the charity hospital system, they gain little exposure to the large
and rapidly growing population of Medicare patients. As a consequence, the charity hospitals and LSU students do not benefit from the experience of treating elderly
patients nor the available federal funding – estimated at $160 million.
LSU should scale up post-hurricane contracts with community hospitals and primary care training sites to expose residents to Medicare patients and qualify for 100
percent federal funding for graduate medical education. The governor and the legislature should ensure that these funds are linked by the medical schools to specific
policy goals, such as increasing the number of primary care physicians or improving the geographic distribution of graduates.
Investment in our future: $160 million savings
- Enhance accountability in state health care spending. Louisiana ranks second in the country in the amount of Medicaid DSH funds spent compared to the numbers
of uninsured, yet the quality of Medicaid care ranks 48th nationwide. The state must do more to implement accountability for performance and quality of health care in
publicly funded programs. The legislature should ensure the current law is enforced, which requires the Department of Health and Hospitals to collect and protect patientspecific
data from both public and private recipients of Medicaid DSH funds. Furthermore, the federal government is prepared to make a 90 percent match, making this
a very cost-effective measure for Louisiana. For the first time, the state would be able to track spending, measure performance, and plan intelligently for meaningful,
system-wide reform.
Investment in our future: $150,000
Louisiana should align itself with the
nationwide trend of the past 25 years to
‘bring health care to the people,’ the reverse
of the charity hospital model of care.
– Public Affairs Research Council, 2007
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