By Robert J. Town, Douglas R. Wholey, Roger D. Feldman and Lawton R. Burns
Health Affairs
July/August 2007
Non-Hispanic whites are significantly more likely to have health insurance coverage than most racial/ethnic minorities, and this differential grew during the 1990s. Similarly, wealthier Americans are more likely to have health insurance than the poor, and this difference also grew over the 1990s. This paper examines the role of provider competition in increasing these disparities in insurance coverage. Over the 1990s, the hospital industry consolidated; we analyze the impact of this consolidation on health insurance take-up for different racial/ethnic minorities and income groups. We found that the hospital consolidation wave increased health insurance disparities along racial and income dimensions.
This paper focuses on the role of hospital consolidation in increasing disparities in health insurance coverage from 1990 to 2003. The link between hospital consolidation and health insurance primarily occurs through the cost of inpatient care. It is well documented that increases in hospital concentration raise the price of inpatient care. These higher costs are potentially passed on to health insurance consumers in the form of higher premiums. Higher premiums, in turn, decrease health insurance coverage. Insurance take-up among racial and ethnic minorities (controlling for income and other household characteristics) and lower-income households (controlling for race/ethnicity and other household characteristics) might be more sensitive to premium increases than is the case for whites and higher-income households.
http://content.healthaffairs.org/cgi/content/full/26/4/1170#R6
Comment:
By Don McCanne, MD
What is the purpose of our health care system? Is it to create successful business models that fulfill the goals of the American entrepreneurial spirit? Or is it to provide health care for all of the people of our nation?
Our national policies should place a priority on health care for everyone, but instead we continue with policies that grant the health care entrepreneurs first priority, regardless of the negative impact on patient care.
Let’s change priorities. Let’s establish policies that mandate that everyone receives the health care that he or she needs. With that as a given, the providers can adopt business principles that would ensure maximum health care value for all of us, while meeting their legitimate costs plus fair profits. (For profits to be fair in health care, passive investors should be eliminated.)
The appropriate policy solutions are clear. It’s the politics that prevent us from enacting these policies. So let’s change the politics.