Email This   Larger Font      Print This   Smaller Font Advertisement 2008 OUTLOOK Over the next few years, nearly every type of health care professional will be in short supply. In Clark County, we're better off than most communities because both WSU Vancouver and Clark College are exceptionally responsive to the community's need for health care professionals and have bolstered their training programs. Hospitals and physicians will continue to deal with high levels of bad debt, charity care and underpayment by government-sponsored programs like Medicaid and Medicare, which pay less than services cost. Upward cost pressure from cross-subsidizing uninsured patients, ever increasing technology and shortages by key professionals will continue to stress our health care system.

Wednesday, January 16, 2008
By Joe Kortum, Columbian forecaster

In the world of economic forecasting there are very few sure things, however predicting increasing demand for health care services may well be a sure thing. Growth of overall population is of course the main reason.

Population characteristics are perhaps even more compelling. With the leading age of the baby boom now 61 years old, a population wave is about to hit the senior ranks, and this wave of demand is expected to continue for a decade or more. In addition, the increasing incidence of obesity and the related occurrence of diabetes, heart disease, orthopedic disorders and cancers will certainly impact health care services in Clark County and throughout the U.S.

In anticipation of this surge in demand, hospitals and physician groups have built new facilities on a scale never seen before in Clark County. Hundreds of millions of dollars of hospital buildings and medical offices have clearly changed our landscape and improved accessibility. Over the next few years construction will slow dramatically, however other major challenges remain for physicians, hospitals and other health care providers.

Short supply

Nearly every type of health care professional seems to be in short supply. Almost everyone is aware of the shortage in nursing (1 million nurses short in the U.S.), but the number of physicians, technologists, radiology techs, pharmacists and many others are also not keeping up. For some medical specialties such as urologists, cardiologists, and anesthesiologists we're already too late. If we increased the number of medical school and residency positions today, the effect wouldn't be felt for five or 10 years.

In Clark County we're better off than most communities because both WSU Vancouver and Clark College are exceptionally responsive to the community's need for health care professionals and have bolstered their training programs.

Also, Southwest Washington Medical Center sponsors a Family Practice Residency Program in affiliation with the University of Washington. This program graduates seven family practice physicians per year in Vancouver.

Recruiting health care professionals from other parts of the U.S. and/or from other countries is proving to be increasingly ineffective since these shortages are a worldwide problem. The best strategy is to train our professional people here and work diligently to keep the people we already have. At Southwest Washington Medical Center, for example, the number of job openings is much better than hospitals throughout the state. Because we've focused on keeping our employees, our employee turnover is 5 percent better than the national average for hospitals.

In my opinion, the most troubling issue facing our health care system is the growing ranks of the uninsured and underinsured. In the U.S. more than 45 million people are without any health insurance, and a disproportionate percentage of them are children. If you add the number of people who are without insurance for at least part of the year, the number swells to 75 million. These people typically have no primary care physician and turn to hospital emergency departments for care, a very expensive place to get primary care. This is an acute problem in Clark County. At more than 100,000 visits per year, Southwest Washington Medical Center has the busiest emergency department in the Portland-Vancouver metro area, and one of the busiest in the U.S.

Building in costs

Hospitals and physicians continue to deal with high levels of bad debt and underpayment by government-sponsored programs like Medicaid and Medicare, which pay less than services cost.

Many of us with commercial health care coverage think these issues of charity care and Medicaid-Medicare under-reimbursement are not our problems, but they are. Hospitals and other providers must build these costs into commercial rates. In fiscal 2007 alone, Southwest Washington Medical Center provided more than $23 million of charity care. If you add to this the Medicaid and Medicare payment shortfalls it comes to $48.4 million. This had to be absorbed into hospital rates.

This hidden "sick tax" is found throughout our health care system and can only be eliminated when we resolve the problem of the uninsured. A recent analysis done in Maryland shows the scale of the hospital cost-shift problem.

For those looking for relief from the growing cost of health care, it's not likely to happen anytime soon. Upward cost pressure from cross-subsidizing uninsured patients, ever increasing technology and shortages of key professionals will continue to stress our health care system.