The American system of health care has relied primarily on privately funded, employer-sponsored insured programs for an individual to receive access to health care services. While this system has worked well for many, it has left behind a large number of Americans — more than 40 million — who lack any form of health insurance at all.
According to the findings of a 2003 study by the V.I. Bureau of Economic Research titled "Virgin Islands Health Care Insurance Access Survey," more than 25 percent of all Virgin Islanders do not have any health insurance at all. That's about 26,000 men, women and children who, for the most part, cannot afford expensive health insurance premiums. Despite the perception by some that the uninsured do not work, this study indicates that 60 percent of these individuals have jobs.
Another telling statistic is that only 4.5 percent of the uninsured go off-island for their health care, while just 11 percent with insurance go off-island. Yes, just 11 percent! This shows that the majority of Virgin Islanders rely on public hospitals and public clinics to receive health care — their safety net. In "safety net" hospitals, many patients have low incomes and are unable to pay for their care. At Roy Lester Schneider Hospital, we provided over $23.7 million in uncompensated care and other services from July 2001 to September 2003. This accounts for approximately 23 percent of the total costs for all the hospital.
Unlike a private health-care facility or office, a safety-net hospital is mandated by law to treat anyone who comes through its doors. Notwithstanding some creative efforts at attempting to collect money from the uninsured and underinsured, our safety-net hospitals realistically collect only a tiny amount of the money owed from treating these patients.
As the number of uninsured patients continues to rise, the burden to provide care to uninsured and underinsured patients increasingly falls on safety-net hospitals. Such hospitals must rely on a variety of funding sources to finance unreimbursed care, including local or state government subsidies, Medicaid and Medicare payments, cost shifting, and other programs.
So how are safety-net hospitals able to stay financially viable? Most are able to do so through a strong level of support from their state or territorial government, or through local subsidies. That kind of support accounts for about 40 percent of our funding.
The second-largest source of support for safety-net hospitals comes from Medicaid, which nationally provides 25 percent of the funds, with the balance consisting of Medicare and other related payments. The Virgin Islands lags behind this national average. Because the territory does not receive the same level of federal matching funds that the states receive, Schneider Hospital receives only 3 percent of its support from Medicaid-related payments.
How can we improve access to health care for the uninsured and underinsured? First, in the absence of a national health care plan, employers must expand their insurance coverage. Second, if we do not adequately support safety-net hospitals, we will need to ensure that individuals can get care on the private market — meaning they will need coverage.
All of this affects the economy. Across the private sector, health providers of different types are beginning to feel the effects of shortages of certain professionals (nurses, pharmacists, technicians)
Yet access to health care is not just a health-care issue; it is an economic development issue, because areas with high rates of uninsurance, like the Virgin Islands, have slower economic growth than areas with low rates of uninsurance. The V.I. government is paying some $200 million in health care costs, and the private sector pays another $200 million. This is money that cannot be diverted somewhere else to boost the economy. In other words, we are all paying in some way for the uninsured!
Safety-net hospitals provide essential, around-the-clock services that everyone needs — emergency room, hemodialysis, labor and pediatrics, and other services that privately owned medical facilities cannot provide. These "public good" services are what define community hospitals as our nation's "safety net," yet we are not providing adequate resources to these providers, given the greater financial burden they have to bear. Like it or not, our territory's growth is inexorably tied to reducing the amount of the uninsured and providing adequate support to our community's safety-net hospital.
Editor's note: Rodney E. Miller Sr. is president and chief executive officer of Roy L. Schneider Hospital.
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