Uwe Reinhardt on administrative incompetence
Hospitals probed on free-care billing
By Christopher Rowland
The Boston Globe
February 11, 2006
Attorney General Thomas Reilly’s office is investigating excessive billing by hospitals to the state’s $800 million free-care pool, a fund used to pay hospitals for treating uninsured patients.
http://www.boston.com/news/local/articles/2006/02/11/
hospitals_probed_on_free_care_billing/
Free-care billing woes highlight health system’s ills
Letters
February 15, 2006
The article “Hospitals probed on free-care billing” (Feb. 11) highlights, once again, the gross incompetence Americans bring to the administration of their health system.
How much cerebral power would it take to stumble upon the idea that there ought to be a common fee schedule on which hospitals bill the state’s free-care pool for healthcare rendered the uninsured? That fee schedule might be the same as Medicaid’s or, because Medicaid is known to pay less than full costs, an average of the prices paid by private insurers, or something in between.
What went through the minds of the state’s bureaucrats when they decided to let each hospital bill the free-care pool at that hospital’s own preferred fees, and then to spend scarce resources on elaborate audits and inspector general’s reports that uncover billing practices that may appear unseemly but probably are perfectly legal?
How is it that Americans cannot even get the simplest things right in their much-vaunted health system? The sheer administrative incompetence both the public and private sectors bring to the health system can explain why this system burns proportionately more resources on administration, and leaves more stakeholders dissatisfied, than does any other health system in the world.
Uwe Reinhardt
James Madison Professor of Political Economy, Princeton University
Comment: By Don McCanne, M.D.
It would be great if our problems could be solved simply by establishing a common fee schedule, but we have a much more serious, structural system failure. Our fragmented system of public payers, private payers, and no payers will always result in gaming through cost shifting. It would not be so bad if it were only a fun game played by the multitude of administrators, but the tragic results remove all of the fun from this deadly game. Not only is it resulting in an explosion in personal financial hardship, it is literally killing people by the thousands.
Many contend that an integrated, highly-regulated, multi-payer system would provide the administrative efficiency that we clearly need. Would that be adequate? As long as we leave in place the many public and private payer/players competing for public and private funds, the games will continue.
With real-life penalties of financial hardship, suffering and death, this is a game that a just society must call off. We need a publicly-administered, publicly-funded, single payer system. No more deadly games, please!