Editorial: Patients are right to worry - Ledger

[Editorial]
Patients are right to worry

Thursday, February 21, 2008

New Jerseyans are wor ried, as they should be, about a recent string of hospital closings and the warnings of more to come.

It is understandable that the most troubled people, as documented by a Rutgers Center for State Health Policy survey re leased this week, are urban residents, minorities and those with low incomes. For many of them, health care has come to mean hospital care, and for the most part, it is the threatened and vulnerable hospitals to which they turn.

The hospital emergency room substitutes for a family doctor. The poor are more often hospitalized because they don't get timely care for their ailments.

Hospitals in New Jersey, by law, must treat all patients whether they can pay or not. The state allocates more than $700 million a year to hospitals for "charity care," but that only partially covers the cost. The charity care deficit is one of the factors dragging down hospitals. And so the fate of lower-in come, uninsured patients is very much entwined with the fate of the hospitals that are struggling to stay afloat.

The hospital crisis and the response to it are being measured in terms of hospital beds lost and hospital beds needed. Much of a hospital's reputation and economics are based on beds built and filled.

Yet the best -- and least expensive -- medical care is now associated with preventive treatment that keeps patients out of hospital beds.

Things must change. Why have so few hospitals been able to redirect noncritical patients from the emergency room to more appropriate and cost-effective settings? Is there something about the relationship between hospitals and doctors who admit patients that must change?

What New Jersey spends on charity care, Medicaid and state-subsidized health insurance for children and low-in come patients adds up to a fortune. Rearranging the distribution of that money in ways that favor the kind of care that is best for patients might fund significant changes in how hospitals function for their own well-being and the well-being of their patients.

The difficulty will be finding a way to do new things without yanking the financial rug out from under the old system while it is still needed.

New Jersey's hospitals are a vital public service, but they are almost entirely held in private hands. The state is obligated to make sure people have access to care but also is obligated to keep a tight rein on government costs.

Both entities are coming to grips with the reality that the current situation cannot be sustained. The answers are elu sive. They must, however, be pinned down, or care for a significant part of the population will continue to deteriorate.

Link to online story HERE.