Venezuela's Medical Exodus, A Result Of Its Contracting Economy, Spurs Fears Of National Health Crisis

 A doctor examines a patient at the Santa Ana public maternity hospital in Caracas.

Venezuelans have long struggled with widespread shortages of goods, ranging from cooking oil to condoms. But they’re also facing a dwindling supply of medical professionals: Thousands of Venezuelan doctors have emigrated from the country in recent years, and some warn that it’s deepening a national healthcare crisis.

Around 13,000 doctors have left Venezuela since 2003, and the vacancies have gone unfilled, said Dr. Douglas León Natera, president of the Venezuelan Medical Federation, in an interview with a local radio station last week. It’s a sizable chunk of the medical community: The federation’s most recent census estimated there were about 70,000 Venezuelan physicians in the country in 2007, 25,000 of whom have died or retired since then, León Natera said. The South American nation's population is about 30.4 million.

The crisis in Venezuela’s healthcare sector is “gradually worsening,” he said.

Venezuela’s healthcare sector had already been struggling with medical supply shortages and funding gaps at hospitals, but last year’s steep drop in the global price of crude oil -- Venezuela’s primary source of income -- has cut the already shrinking budget for medical supplies and hospital expenses, prompting more healthcare professionals to leave.

“The budget for healthcare has diminished significantly,” said Dr. Jose Antonio Cisneros, a physician from Venezuela who has been practicing in the United States for more than 20 years. “There are fewer resources to import technology and bring in drugs that are necessary to keep up the quality of care.”

The outflow of doctors is part of a larger exodus of Venezuelan professionals, including engineers who once ran the country's sizable petroleum sector, who are able to market their skills elsewhere. Analysts warn that inflation could climb near 200 percent in 2015, while the International Monetary Fund projected a 7 percent contraction in the gross domestic product. Meanwhile, festering crime and hours of waiting in supermarket lines for scarce goods have weaved into Venezuelans' daily lives.
The impetus to leave is increasingly affecting younger physicians coming out of medical school. Medical students and recent graduates, frustrated by the lack of resources and opportunities to advance professionally, are looking overseas to finish their education and build out their careers, as they see dimmer futures in Venezuela.

But the exodus may be leading to an alarming void in Venezuela’s healthcare sector. “In a few years, you’re going to find a gap,” Cisneros said. “You’re going to either have young doctors coming right out of medical school, or doctors who are too old. Doctors between the age of 35 and 50 -- the most productive times for a physician – are going to be just gone.” The best students are the first to leave, he added.

Pablo Pérez d’Empaire, a Venezuela native who’s currently an anesthesia resident at the University of Toronto, agrees that's where the healthcare sector is heading. “Before I left, I heard a lot of my professors and teachers in medical school saying, ‘I don’t know who’s going to be taking care of us,’” he said. He moved to Canada five years ago, fueled by a desire for professional growth and wariness of the increasing crime and instability in Venezuela.

The economic crisis has already taken its toll in the health sector in extreme ways. Some hospitals reportedly began performing more mastectomies in recent months to treat breast cancer because they were unable to get reliable access to radiation machines. Venezuelans unable to get access to prescription drugs have also turned to social media to barter for medications.

Last year, Venezuela also saw a resurgence of diseases that had long been eradicated. Malaria resurfaced for the first time in 50 years, and dengue fever cases rose nearly 50 percent in 2014 from the year before. The chikungunya virus, a similar mosquito-transmitted disease, also began spreading through the country.

Some of the frustration in the medical community stems from the beginning of Hugo Chávez’s presidency, when his government pioneered a social program known as Barrio Adentro designed to bring healthcare access to poor communities. It was popular among the poor, but also created a parallel system of medical training that critics say is much weaker than traditional medical education in universities and graduate schools.

The administration’s emphasis on those programs, based heavily on primary care, turned government attention away from the traditional health system, including hospital-based and specialist care. The fact that the administration also brought in Cuban medical professionals for the Barrio Adentro program, in exchange for heavily discounted Venezuelan oil, sowed more resentment from Venezuela’s medical community. (Hundreds of Cuban doctors have also defected from their posts in Venezuela and ended up in the U.S. through a special parole program.)

As traditionally trained doctors find options outside of Venezuela, patients will eventually rely more on those community doctors from the parallel system, said Adriana Tami-Grundmann, a doctor from Venezuela now working at the University Medical Center Groningen in the Netherlands.

"The doctors who have experience and can train the younger generations, they are leaving," she said. "The country will keep these new doctors who are not well trained, and it's a huge danger for health. Patients don't know which are trained in the new Bolivarian system or in the traditional, proper university system."

As public hospitals began to feel the economic squeeze, much of the burden shifted to private hospitals and clinics in recent years, overwhelming facilities and burdening doctors with heavier workloads. Exchange rate fluctuations and import restrictions have also prevented those facilities from accessing equipment and supplies they need.

Students who have excelled in school and are proficient in English can generally make their way into the U.S. healthcare sector without much difficulty, Cisneros said. He noted that aging baby boomers and the addition of millions more insured Americans through the Affordable Care Act have amplified U.S. demand for doctors that foreign medical professionals can fill.

But Pérez d’Empaire said a job in the U.S. isn’t always guaranteed. “Unfortunately, spots are not always available for people who want to leave,” he said. Some people unable to get opportunities in other countries have instead gone into research or education -- or changed fields completely. “You can find physicians who are even driving a taxi because they have to support themselves or their families and are not able to practice medicine anymore,” he said.

While Venezuela’s doctor flight is part of the healthcare crisis, Pérez d’Empaire doesn’t think staying in the country will help the situation. “It’s out of their power,” he said. “Unfortunately, the government has shown that they’re not really interested in improving the conditions for traditionally trained doctors.”

Tami-Grundmann said many of her colleagues are still choosing to stay in Venezuela's public hospitals to keep quality care in the system. "Not everybody is fleeing," she said.

"But this is a humanitarian crisis that is happening in Venezuela," she added. "Thousands of people are dying every year, not only from violence but because of lack of healthcare."

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A five-star hospital? Government unveils new ratings

Looking to make it easier to compare hospitals, the federal government has started awarding star ratings to medical centers based on patients' appraisals.

Many of the nation's leading hospitals received middling ratings, while comparatively obscure local hospitals and others that specialized in lucrative surgeries frequently received the most stars.

Evaluating hospitals is becoming increasingly important as more insurance plans offer patients limited choices. Medicare already uses stars to rate nursing homes, dialysis centers and private Medicare Advantage insurance plans.

While Medicare publishes more than 100 quality measures about hospitals on its Hospital Compare website, many are hard to decipher. There is little evidence consumers use the site very much.

Many in the hospital industry fear Medicare's five-star scale won't accurately reflect quality and may place too much weight on patient reviews, which are just one measurement of hospital quality. Medicare also reports the results of hospital care, such as how many people died or got infections during their stay, but those are not yet assigned stars.

"We want to expand this to other areas like clinical outcomes and safety over time, but we thought patient experience would be very understandable to consumers so we started there," Dr. Patrick Conway, chief medical officer for the Centers for Medicare & Medicaid Services, or CMS, said.

Medicare's new summary star rating, posted Thursday on its Hospital Compare website, is based on 11 facets of patient experience, including how well doctors and nurses communicated, how well patients believed their pain was addressed, and whether they would recommend the hospital to others. Hospitals collect the reviews by randomly surveying adult patients -- not just those on Medicare — after they leave the facility.

In assigning stars, Medicare compared hospital against each other, essentially grading on a curve. It noted on its Hospital Compare website that "a 1-star rating does not mean that you will receive poor care from a hospital" and that "we suggest that you use the star rating along with other quality information when making decisions about choosing a hospital."

The American Hospital Association also issued a caution to patients, saying "There's a risk of oversimplifying the complexity of quality care or misinterpreting what is important to a particular patient, especially since patients seek care for many different reasons."

Nationally, Medicare awarded the top rating of five stars to 251 hospitals, about 7% of all the hospitals Medicare judged, a Kaiser Health News analysis found. Many are small specialty hospitals that focus on lucrative elective operations such as spine, heart or knee surgeries. They have traditionally received more positive patient reviews than have general hospitals, where a diversity of sicknesses and chaotic emergency rooms make it more likely patients will have a bad experience.

A few five-star hospitals are part of well-respected systems, such as the Mayo Clinic's hospitals in Phoenix, Jacksonville, Fla. and New Prague, Minn. Mayo's flagship hospital in Rochester, Minn., received four stars.

Medicare awarded three stars to some of the nation's most esteemed hospitals, including Cedars-Sinai Medical Center in Los Angeles, NewYork-Presbyterian Hospital in Manhattan and Northwestern Memorial Hospital in Chicago. The government gave its lowest rating of one star to 101 hospitals, or 3%.

On average, hospitals scored highest in Maine, Nebraska, South Dakota, Wisconsin and Minnesota, KHN found. Thirty four states had zero one-star hospitals.

Hospitals in Maryland, Nevada, New York, New Jersey, Florida, California and the District of Columbia scored lowest on average. Thirteen states and the District of Columbia did not have a single five-star hospital.

In total, Medicare assigned star ratings to 3,553 hospitals based on the experiences of patients who were admitted between July 2013 and June 2014.

While the stars are new, the results of the patient satisfaction surveys are not. They are presented on Hospital Compare as percentages, such as the share of patients who said their room was always quiet at night. Often, hospitals can differ by just a percentage point or two, and until now Medicare did not indicate what differences it considered significant. Medicare also uses patient reviews in doling out bonuses or penalties to hospitals based on their quality each year.

Some groups that do their own efforts to evaluate hospital quality questioned whether the new star ratings would help consumers. Evan Marks, an executive at Healthgrades, which publishes lists of top hospitals, said it was unlikely consumers would flock to the government's rating without an aggressive effort to make them aware of it.

Jean Chenoweth, an executive at Truven Health Analytics, which also publishes its own list of top hospitals, said she feared hospital marketing departments would oversell the meaning of the stars.
"It would be very unfortunate and misleading if a hospital marketing department could claim to be a CMS five-star hospital and fail to mention it only reflected a patients' perception of care," she said.

How to find a hospital's star rating:
Go to Hospital Compare's web site
Type in your zip code and/or hospital name
Select up to three hospitals by clicking the "Add to compare" button
Under Compare Hospitals title, click "Survey of patients' experiences" tab
Scroll down to the star rating

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Gov. Rick Scott sues feds over healthcare money, Medicaid expansion

Republican Gov. Rick Scott announced Thursday that he will sue the federal government for allegedly coercing Florida to expand Medicaid.

“It is appalling that President Obama would cut off federal healthcare dollars to Florida in an effort to force our state further into Obamacare,” Scott said in a statement.

The legal maneuver, which comes amid a tense standoff between the House and Senate over Medicaid expansion, was simultaneously lauded and lambasted. It also complicates negotiations over this year’s budget.

The agency targeted by the lawsuit — the U.S. Centers for Medicare and Medicaid Services, or CMS — is still deciding whether to renew a $2.2 billion program called the Low Income Pool that helps Florida hospitals treat low-income patients. And if no LIP dollars are awarded, Florida could be looking at a $1.3 billion budget gap.

“From where I sit, it is difficult to understand how suing CMS on day 45 of a 60-day session regarding an issue the state has been aware of for the last 12 months will yield a timely resolution to the critical healthcare challenges facing our state,” said Senate President Andy Gardiner, R-Orlando.
The suit, which has yet to be filed, is only the latest round in an ongoing feud between Scott and CMS in connection with the LIP.

The program is scheduled to expire in June under an agreement between Florida and the federal government. Federal health officials have said that they are open to negotiating a successor program, but no deal has been reached.

The negotiations took a turn Tuesday, when CMS told Florida’s Agency for Health Care Administration that any decision regarding LIP would be tied to whether the state accepts federal Medicaid expansion money — a politically charged policy option Scott once supported, but now opposes.

Scott blasted CMS Thursday, saying that linking the two issues violated a U.S. Supreme Court ruling “that the president cannot force Medicaid expansion on states.”

“Not only does President Obama’s end to LIP funding in Florida violate the law by crossing the line into a coercion tactic for Obamacare, it also threatens poor families’ access to the safety net healthcare services they need,” Scott said.

He called the actions “outrageous and specifically what the Supreme Court warned against.”
CMS declined to comment on the planned lawsuit. But spokesperson Ben Wakana said that Florida, as are other states, “is free to implement Medicaid expansion or not.”

Wakana pointed out that the LIP program had “long been scheduled to expire on June 30.”
“Florida is requesting an additional optional extension, which raises a different question: whether it promotes the objectives of the Medicaid statute to use demonstration authority when the state has statutory options that would better serve the low-income population,” he said.

White House Press Secretary Josh Earnest said that he hadn’t seen the details of the lawsuit, but that expanding Medicaid would ensure that 800,000 Floridians get access to healthcare coverage.
“So there’s not a good reason why anybody in Florida would be in a situation of trying to block a policy that would benefit 800,000 Floridians,” he said.

In Tallahassee, Scott’s announcement Thursday exposed the deepening divide between the House, which opposes expansion, and the Senate, which supports expansion and has proposed a plan to extend the LIP program.

House Speaker Steve Crisafulli said that Scott was making an important point: “You can’t force the state to take on Medicaid expansion.”

Senate Appropriations Chairman Tom Lee, R-Brandon, said he wasn’t sure whether the move was political posturing, or whether Scott has the standing to bring the lawsuit.

“But if they think the federal government has stepped out of bounds, they’ve got an obligation to defend the state of Florida,” he said.

Scott has repeatedly tangled with the federal courts when defending his policies or challenging the federal government.

Last year, Scott’s Agency for Health Care Administration filed suit against the U.S. Department of Veterans Affairs, accusing the agency of providing substandard care to veterans after AHCA inspectors were denied access to federal VA hospitals.

The governor also asked the U.S. Supreme Court last year to hear his appeal of a federal court ruling that he issued an unconstitutional executive order in 2011 that allowed drug testing of state workers. The nation’s high court declined to hear the case.

Scott last year dropped the state’s appeal of a federal court order that deemed Florida had illegally begun a statewide “purge” of suspected non-citizens from the voter rolls less than 90 days before an election, which is not allowed by federal law.

The latest threat of legal action drew a collective groan among Democrats, who called the case “ridiculous.”
“It’s more of the same from the governor,” said House Democratic Leader Mark Pafford, of West Palm Beach. “It’s a corporate reaction: We sue people. The sad thing is it is going to cost the taxpayers.”

U.S. Rep. Kathy Castor, D-Tampa, said Scott was “not playing it straight.”

“The state of Florida has known for a year that LIP funding is expiring, and this hypocritical stunt by Gov. Scott will do nothing to serve our neighbors, Florida hospitals or Florida businesses,” she said.

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Read more here: http://www.miamiherald.com/news/politics-government/state-politics/article18676365.html#storylink=cpy

Hospitals Leave Downtowns for More Prosperous Digs

Aging buildings, changing demographics spur flight to suburbs.

Nearly as old as the railroad that slices through this southern Illinois city just east of the Mississippi River, St. Elizabeth's Hospital has been a downtown bedrock since 1875.

Started by three nuns from a Franciscan order in Germany, the Catholic hospital still seeks "to embody Christ's healing love" to the sick, the aged and the poor, according to its mission statement. It is so tied to the city that when the local economy slumped in 2009, the nonprofit St. Elizabeth's gave $20 to every employee to spend on Main Street, sending hundreds of shoppers out to the mostly mom- and pop-owned stores.

But St. E's, as locals call it, now faces its own financial troubles, largely a result of the costs of maintaining an obsolete facility and of treating more low-income and uninsured patients from Belleville and neighboring East St. Louis, one of the poorest cities in the Midwest.

After a decade of losing money, St. Elizabeth's officials are taking a radical step: Like a small but growing number of hospitals around the country, they plan to close the 303-bed hospital and move elsewhere. They are seeking state approval to build a $300-million facility 7 miles northeast, in O'Fallon, a wealthier city that is one of the fastest-growing communities in the St. Louis region with new subdivisions, proximity to a regional mall and quick access to Interstate 64.

Describing plans to leave behind some services, including a walk-in clinic, St. Elizabeth's CEO Maryann Reese insists the hospital is not abandoning the city or the poor.

But that's exactly how many residents, community leaders and clergy see it. If St. Elizabeth's leaves downtown, they say, it will limit care for many poorer residents, especially those dependent on public transportation, and lead to overcrowding at the city's one other hospital, which is downsizing. Many also worry about the loss of jobs and of the visitors to the hospital who patronize local shops and eateries.

Geri Boyer, who runs a bed and breakfast and an engineering firm on Main Street, said that as a Catholic, she's "appalled" by the hospital's plan. "I do think they are putting profit motivations over the mission of serving the poor. I am upset and embarrassed for [them]."

"Communities can be tipped by the loss of a vital medical institution," Belleville Police Capt. John Moody II wrote in a scathing letter about the plan to a state review board. "There is too much at stake and the loss will be catastrophic and I fear unrecoverable."

Geography Is Destiny
Hospitals have moved to follow population migrations before, but the relocations are becoming more common. That's partly due to the aging of many facilities built in the 1950s and 1960s, and the desire to attract better-paying patients. A 2012 Health Affairs study found that hospitals in 12 markets used geographic expansion strategies, including building new hospitals or adding freestanding emergency departments, to "capture" well-insured patients.

"Where you choose to place new facilities almost always involves moving to an area where there is a substantial privately insured population," said Paul Ginsburg, chairman of medicine and public policy at the University of Southern California.

Currently, hospital relocations are planned or underway in South and Central Florida, eastern Tennessee, central Georgia, Birmingham, Ala., and northeast Ohio. Some have stirred controversy, as in Belleville:

• Just west of Fort Lauderdale, HCA Inc., a for-profit hospital chain, plans to close Plantation General Hospital and open a new hospital 7 miles away in more affluent Davie, near a medical school. "It's all about greed," said Plantation Mayor Diane Bendekovic. When HCA offered to keep some outpatient services in town, she told them: "Don't throw Plantation any crumbs."

• Tennova Healthcare is moving its flagship Physicians Regional Medical Center near downtown Knoxville, Tenn. closer to higher-income suburbs 8 miles west. "Clearly ... they want to be near the better ZIP codes" said Tony Spezia, CEO of Covenant Health, owner of Fort Sanders Regional Medical Center, which will become the last general hospital downtown. Tennova is owned by Community Health Systems, a large for-profit hospital system.

• Just outside Cleveland, Lakewood Hospital in Lakewood, Ohio, which is managed by the Cleveland Clinic, is slated to close in 2016, and patients will be directed to the Clinic's newer Fairview Hospital 3 miles away or to another facility being built in Avon, 13 miles away. Both Fairview and Avon are higher-income towns. Lakewood officials say losing the hospital and its 1,000 employees could have a prolonged impact.

Hospital officials point to their aging, landlocked facilities and argue it is cheaper to build, rather than renovate. What they don't say publicly is how geography is often economic destiny for a hospital, especially at a time of increasing financial pressure as a result of Medicare funding cuts, including penalties that may result from new pay-for-performance measures in the Affordable Care Act.

By moving to wealthier areas, hospitals can reduce the percent of uninsured and lower-paying Medicaid patients, while increasing the proportion of privately insured patients -- what hospitals refer to as attracting better "payer mix." That's also why they locate outpatient centers and medical offices in affluent suburbs. But relocations often spark anger from those left behind, who worry about loss of jobs and of access to care, particularly for the poor.

When the hospitals are nonprofits, like St. Elizabeth's, questions loom larger because they are exempted from taxes in exchange for providing benefits to the community. "Hospitals were established in inner cities where the greatest needs were and now, essentially, that charity obligation has gone by the wayside as they are looking at their bottom line," said Gerard Anderson, director of the Center for Hospital Finance and Management at the Johns Hopkins Bloomberg School of Public Health.

Even nonprofit hospitals want to be near wealthier residents. "You move to where the money is," he said.

Hospital Moves

Hospitals are increasingly relocating as they follow population growth and look for greater accessibility and more privately insured patients.
Here are some pending moves:

• St. Elizabeth's Hospital: Moving from Belleville, Ill., to O'Fallon, Ill.

• Plantation General Hospital: Moving from Plantation, Fla., to Davie, Fla.

• Physicians Regional Medical Center: Moving from near downtown Knoxville, Tenn., to West Knoxville

• Northside Hospital-Cherokee: Moving from north Canton, Ga. to Highway 20 near Canton Marketplace

• Florida Hospital Apopka: Moving from downtown Apopka, Fla., several miles away near the intersection of several state roads

• Lakewood Hospital: Closing in Lakewood, Ohio, after the opening of Avon Hospital in Avon, Ohio
• Riverside Shore Memorial Hospital: Moving from Northampton County, Va., to Accomack County, Va.

• Mount Carmel Health System: Moving from Franklinton, Ohio, to Grove City, Ohio

And some recently completed:

• Roane Medical Center, from downtown Harriman, Tenn., to Midtown, Tenn

• St. Mary's Health Center, from downtown Jefferson City, Mo., to a location near two highways

• Wellstar Paulding Hospital, from Dallas, Ga., to Hiram, Ga.

• Martha Jefferson Hospital, from downtown Charlottesville, Va., to a suburban location several miles east

• St. Joseph Regional Medical Center, from South Bend, Ind., to Mishawaka, Ind.

• Porter Regional Hospital, from downtown Valparaiso, Ind., to the intersection of two highways several miles away

• Boulder Community Foothills Hospital, from downtown Boulder, Colo., to a site several miles east

'Built for Healthcare in the 1950s'
That doesn't sit well with Belleville Mayor Mark Eckert, who was born at St. Elizabeth's, drove an ambulance there when he was a teenager, and now lives three blocks away where he can see the lights on the hospital helipad from his living room. He fears the move will leave barren whole blocks in the middle of the city, devastate the downtown economy, and make it more difficult for some people to get care.

"They are definitely running from the poor," he said.

St. Elizabeth's officials deny that, noting that only a quarter of their patients come from Belleville and the new site will be closer to the majority who live in other communities, including eight of the 10 ZIP codes in their service area with the highest poverty rates. "Being more centrally located will also make care more accessible for everyone, regardless of income," the hospital said in a statement.
But the hospital faces a perception problem, in part because Belleville is older and poorer than O'Fallon. Median household income in Belleville is about $47,000, compared to over $75,000 in O'Fallon. By moving northeast, the hospital also moves farther away from East St. Louis, though hospital officials say the interstate location shortens drive time. Eckert says many poor people don't have cars and there is no direct public transportation to the O'Fallon site.

Eckert does not dispute that St. Elizabeth's is under stress and needs to modernize. The hospital lost $10.5 million on $148 million in revenue in 2013, according to its latest audited financial statement. That same year, Springfield, Ill.-based Hospital Sisters Health System, which owns St. Elizabeth's and 13 other hospitals in Illinois and Wisconsin, made $168 million on nearly $2 billion in revenue.
Most of St. Elizabeth's operates out of a 60-year-old building that administrators say is difficult for many people to get to because of one-way roads. In addition, they say, patient rooms are too small and the waiting area for the emergency room is cramped.

"It is extremely challenging to operate a hospital that was designed and built for healthcare in the 1950s," Reese, the CEO, told a state regulatory board that reviews major hospital projects at a January hearing. With several members absent, the board voted down the relocation. But under state rules, the hospital can respond to its concerns and a second hearing and vote are expected on April 21.

Eckert said the city offered to help St. Elizabeth's rebuild downtown and even suggested another location adjacent to a college and a train line on the edge of town. But like so many other businesses that have left Belleville, hospital officials wanted quick access to the interstate. Hospital officials say they considered locations in Belleville, but settled on 114 acres of farmland they bought in O'Fallon in 2011 as a site to build a 144-bed facility.

Move Angers Rival Hospital
Another vehement opponent is Memorial Hospital, a few miles from downtown and the only other hospital in Belleville. It, too, is targeting the more affluent population to the east of the city -- building a 94-bed hospital in Shiloh, also just off the interstate and a 5-minute drive from the proposed site for St. Elizabeth's. State officials approved that facility in 2011 -- over the objection of St. Elizabeth's, which claimed there was no need for it.

"As a nonprofit community hospital, we want to fulfill our mission -- and meet our budgetary needs," said Memorial CEO Mark Turner. "And to do that, there has to be enough money coming in to pay for that."

Unlike St. Elizabeth's, though, Memorial retained its Belleville hospital, albeit with fewer beds. Memorial officials say they fear that if St. Elizabeth's moves, their Belleville hospital will be overwhelmed and will get most of the area's uninsured and Medicaid patients. Memorial also worries the new St. Elizabeth's will pull the best-paying patients from its new hospital set to open next year.
Most opponents support St. Elizabeth's building a new hospital, but they want it in Belleville. "Why do you want to be further away from the people you are helping?" asked Stephanie Dorris, who helps lead a community group opposing the move, pointing to the empty lots around the hospital.
That was the same question some asked in South Bend, Ind. in 2009, when St. Joseph Regional Medical Center left its downtown location after 125 years for the richer and faster growing suburb of Mishawaka, 7 miles away. In its final year in South Bend, St. Joseph lost $42 million.
In the years since, the nonprofit Catholic hospital has made about $50 million in profit, financial statements show.

But Karl Nichols, who heads the St. Joseph County Minority Health Coalition, said that hospital's departure has hurt the poor. He said that those without cars have less access to care and the city's remaining hospital is overburdened.

'You Have To Be Prepared'
Driving through Belleville on a recent morning, police Capt. Moody raises other concerns. As he passes several elementary schools close to St. Elizabeth's with children playing outside at recess, he worries about the unthinkable: how the loss of the hospital might affect response to, say, a mass shooting. "You have to be prepared," he said.

He credits St. Elizabeth's with saving the life of a Belleville police officer who was shot in 2006 two blocks from the hospital. "People here feel secure knowing St. E's is where it is," Moody said.
Marilyn Lanter, 61, who works at Community Kindness Resale Shop on Main Street in Belleville, says she's been treated at St. Elizabeth's at least six times over 20 years. "It's a place I trust with my life," she said. "It's comforting to have the hospital so close, particularly for people like me who don't drive."

The drive from the existing hospital in Belleville to the proposed location in O'Fallon takes 15 to 20 minutes, but it's like going through a time warp. St. Elizabeth's sits across from the gothic-style St. Peter's Cathedral down the street from a post office, a Catholic school, a Boy Scouts office and the City of Belleville Parks and Recreation building. In contrast, the O'Fallon hospital site is behind a Hilton Garden Inn and just across the interstate from shopping centers that include a Target and other big box retailers.

Rev. Joshua Pittman of St. Paul's United Church of Christ is philosophical about the proposed change even though it will cause pain. "Churches move too," he said. "It's what happens when saw mills close down and people move."

But to Rev. Monsignor John Myler, rector of St. Peter's, the plan seems a betrayal. "'Only 7 miles is quite a distance for the poor, who have no means of transportation," he wrote in opposition. "It is contrary to Francis to ask those in need to travel to him. Rather Franciscans are -- and have been for centuries -- right among the people, not in a well-to-do place, asking the people instead to come to them."

This article, which first appeared April 13, 2015, also appeared in USA Today and was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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Economy, hospitals have stake in expansion - Nebraska

Care too costly - In 2013, Nebraska experienced more than 4,800 bankruptcies of which an estimated 2,800 had a significant medical debt component.

 

Nebraska lawmakers, who this week killed Medicaid expansion for the third consecutive year, should at least perform an interim study so they can return in 2016 with the knowledge to conduct a more thoughtful debate on whether it’s wise to extend health care to more low-income Nebraskans.

It was ignorance that doomed the expansion proposal this year and allowed legislators to be suckered by opponents’ Obamacare bogey man arguments. Among the most vocal opponents, Gov. Pete Ricketts complained the Medicaid proposal was an unaffordable expansion of government and that Nebraskans could not rely on Uncle Sam to continue with its share of funding.

Supporters of the measure said Nebraska will miss out on billions in federal funds and leave almost 77,000 people without health coverage.

Those 77,000 uninsured Nebraskans are time bombs who threaten the financial health of small rural hospitals that cannot absorb the costs of non-paying patients. Last year, the town of Tilden lost its hospital, and now others could be at risk.

In their cost/benefit study of the proposed Medicaid expansion, two University of Nebraska at Kearney professors concluded that providing health coverage for low-income Nebraskans is, in effect, an insurance policy against bankruptcy for hospitals.

The study by UNK economics professor Allan Jenkins and management professor Ron Konecny noted that during the first five years of expansion, the state would receive nearly $2.1 billion — or about $992,000 daily — in federal expansion funding.

“These are dollars Nebraska taxpayers are currently sending to Washington, D.C., that could be recaptured to contribute to the state’s economy and a healthier, more productive workforce,” said the study’s executive summary. The UNK profs concluded that infusing $2.1 billion in federal money would generate $5 billion in increased economic activity in Nebraska.

Saving rural hospitals, boosting economic activity and creating jobs are logical reasons to expand Medicaid, but there also are moral arguments. Why should 77,000 low-income Nebraskans be denied health coverage when providing it could be such a boon to the state?

Lawmakers need to know more. An interim study is needed. Also needed is a stronger, united voice from the Nebraska Hospital Association and other interests who intimately understand what is at stake.

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The key reforms of France's healthcare bill

As part of controversial healthcare reforms presented to French Parliament on Tuesday, France is taking aim at everything from smoking to doctor's fees. Here are eight things you need to know about the new bill.

France is known for its excellent healthcare system as well as the long life expectancy rates of its residents, but the country still has significant health-related issues its trying to fix.

Under a sweeping health reform bill that has already seen doctors striking across the country on several occasions in the last month, Health Minister Marisol Touraine is targeting some of the most critical problems.

France’s national healthcare insurance system, the "Assurance Maladie", aims to use the reforms to make €10 billion in cuts over the next three years.

Here are eight major points in the bill:

Smoking crackdown: In an effort to take some of the glamour out of smoking, Touraine’s bill proposes wiping the colourful branding and well-known logos off cigarette packs. She also plans to outlaw e-cigarette use in certain public places like parks where children are present. The crackdown on smoking also includes a plan to ban the habit in cars with children in. Despite France’s reputation for healthy living, smoking is a major problem here and it’s tied to 73,000 deaths per year.

Clean rooms for drug users: Touraine is hoping to at last lay the groundwork that would allow for trial runs of a limited number of so-called "shooting galleries". These are places where intravenous drug users would have access to clean needles, sanitized facilities and access to drug counselors. However the project has been endlessly delayed by opponents who view the plan as coddling hard drug users.

Binge drinking ban: If it is passed, people who encourage minors to drink excessively could face a year behind bars and a €15,000 fine. And anyone who incites others to “drink until drunk” could face up to six months in prison as well as a fine into the thousands.

Digital doctors records: France already has a system whereby patients’ records are supposed to be digitized, but it never really took off. So Touraine is giving it another try, this time putting the Assurance Maladie in charge of the initiative. Digital records are seen as the future for hospitals around the world and help doctors coordinate care, but also provide a means to keep patients informed and involved.

Payment-free doctors visits: The bill would end the current system that sees patients cover part of the cost of a doctor’s visit. It would come into effect for special cases by 2015 and by 2017 for everyone. The idea is to better prevent illness, which is less costly and produces better results than trying to treat a problem that’s long gone unchecked.

Abortion rule changes: The reform aims to get rid of the seven-day "cool-off period" for getting an abortion, which is in place to allow patients a chance to change their mind. Women must currently wait a week between two medical consultations in order to be allowed an abortion. In emergency cases, for example if the woman is approaching her 12th week of pregnancy, this seven-day period can be reduced to 48 hours.

Organ donation register: The new reforms say that people should have to sign up to NOT be on the organ donor list. France currently works on a system of assumed consent, but if the reform gets through, French people will have to sign a national registry saying they don't want their organs donated to circumvent this. It would come into place in 2018.

Cancer survivors' right to be forgotten: Touraine's reforms say that anyone in France who is 100 percent cured from cancer has the right to have their medical record "forgotten". This means that when they're applying for jobs or requesting loans, they can avoid any potential forms of discrimination.

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Chinese Healthcare System On the Road to Reform – Double the Doctors

Refreshing news reached the public when the main Chinese administrative authority announced a very ambitious plan: doubling the number of doctors by 2020. And that is not all of it.

China has become more aware of the need to trim its public sector and boost technology use in hospitals if it wants to revive a very deficient healthcare system. As if this task was not enough, the system is aiming at decreasing queues and improving rural service.

McKinsey & Co have reported an increasing global interest in China’s fast-growing healthcare market – medical device firms, drug makers and hospital operators – they all want a piece of the healthcare bill. Their interest isn’t completely misplaced as the profits are expected to reach $1 trillion by 2020.

Monday night, China’s State Council gave a statement touching all the things that are currently going wrong in the Chinese healthcare system: insufficient resources, poor quality of services, bad organization of facilities, and sever fragmentation of service systems.

Next in his speech, he presented a five-year roadmap pinpointing all the targets that need improving between 2015 and 2020. By the end of the project, Beijing hopes that two doctors will cover a thousand people – which translates in almost double the doctors reported in 2013.

Besides general doctors, the government intends a significant increase in support staff and nursing. The most common cause of the lack of doctors in China is the absurdly low salaries, resulting in an ever-growing tension between underpaid medical practitioners and their frustrated patients.

Involving technology more and more in the system is another target, and China plans including mobile devices and online “cloud systems” as a part of the solution. Alibaba Group Holding Ltd with its healthcare subordinate Alibaba Health Information Technology Ltd stands to gain a great profit from the up-coming changes.

Health records are also set to move to digital databases, centralizing patient information for most of the (if not the entire) population by 2020.

President Xi Jinping’s government is using different strategies to provide access to affordable healthcare as a key platform. One issue that needs change the most and the fastest is eradicating corruption in the sector, as patients complain about large out-of-pocket expenses because insurance doesn’t cover as much of the medical procedures as it should.

Due to increasing interest shown by national and international firms, the Chinese roadmap recommended more access to those who want to take up the role of running hospitals. Public health institutions cannot continue accounting for around 90 percent of the total number of hospital beds, so it is opening to the private sector.

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Wendell Potter: Alabama OB-GYN whose patient died, pushed for ‘drive-through deliveries’

During his campaign for the Alabama Legislature last year, now-state Sen. Larry Stutts, a Sheffield Republican and OB-GYN, vowed to get the government out of the middle of the patient-physician relationship. He made no mention of the fact that what he really had in mind was putting insurance companies back in the middle of that relationship.

Stutts, who until a few days ago was considered a rising-star in the state Republican party, made national news because of the furor caused by what might go down in history as the most ill-advised bill any lawmaker could possibly sponsor.

Did he really think no one would notice that the law he wanted to get rid of was enacted because of the death of one of his patients?

By the end of last week, this former up-and-comer, whose bill would once again allow insurance companies to decide when a mother and her newborn would have to leave the hospital, had been labeled a pariah. Alabama political reporter Bill Britt wrote this about him: “Stutts is arrogant and careless and now we know he is evil.”

In 1998, Rose Church, a 36-year-old nurse who was one of Stutts’ patients, died of a heart attack soon after giving birth to a baby girl. An autopsy revealed that she had developed severe bleeding and that a part of the placenta had been left in her womb.

Rose was discharged just 36 hours after she gave birth. Gene Church believes that had his wife not been sent home so soon, at the insistence of their insurer, she might still be alive.

With his baby daughter in his arms, Gene spent many hours in Montgomery trying to persuade legislators that insurers should not be allowed to make medical decisions. He argued that they should be required to pay for at least a 48-hour stay in the hospital following a normal delivery and a 96-hour stay following a Cesarean section or complicated delivery. His efforts paid off. The Alabama Legislature in 1999 unanimously approved what came to be called “Rose’s Law.”

Alabama was not the first state to pass such a law. In fact, it was one of the last. In the mid-1990s, dozens of states began passing similar bills following a backlash against what was perceived to be inappropriate interference by insurance companies in the patient-physician relationship.

In the early 1990s, HMOs and other insurers began implementing hospital length-of-stay policies based on guidelines developed by an actuarial firm, Milliman & Robertson (now called Milliman). As a consequence, employees of managed care companies were calling the shots on how long mothers and their newborns could stay in the hospital.

The early discharges came to be called “drive-through deliveries” and were the subject of countless media stories. I’ll never forget that time because I was on the front lines of the backlash. As a spokesman for Cigna, I had the unenviable responsibility of responding to a seemingly endless stream of calls from reporters seeking comment about the company’s discharge guidelines.

It wasn’t long before politicians of both parties were condemning drive-through deliveries. Two of the U.S. Senate’s most conservative members, Republicans Jesse Helms of North Carolina and Mike DeWine of Ohio, denounced drive-through deliveries as “unconscionable.”

By 1997, more than 40 states had enacted bills to force insurers to end the practice. In Washington, Congress passed the “Newborns’ and Mothers’ Health Protection Act.” The Senate version had more than 50 cosponsors, including Helms and DeWine.

Among the most vocal advocates of the legislation were doctors who were outraged that managed care companies were able, for all practical purposes, to tell them how to practice medicine.
“I think that the decision for when a newborn and their family needs to go home is a mutual one that should be decided between the family and their provider,” Dr Lenna Liu, a professor of pediatrics at the University of Washington, told CNN in 1997. “It’s not a decision that administrators or managed care people should be making.”

Liu was quoted in the CNN story about a study that found that newborns discharged early were more vulnerable to several conditions including jaundice, dehydration and sepsis and consequently more likely to be re-admitted to the hospital.

I couldn’t find any stories from the 1990s quoting Larry Stutts about drive-through deliveries, but I did find a number of recent stories in which he attempted to conflate Rose’s Law with Obamacare. During his campaign last year, he promised voters that if they helped him defeat Roger Bedford, the Democratic incumbent, he would be “standing against OBAMACARE and all interference in the doctor-patient relationship.”

When Gene Church found out what Stutts was up to a few weeks ago, he made certain that it would not go unnoticed that the law Stutts was trying to get rid of was the very one named 16 years ago for one of Stutt’s patients. A patient who might be alive today had it not been for the “unconscionable” interference in the doctor-patient relationship — not by government, as Stutts would like us to believe, but by insurance companies.

This commentary was originally published by the Center for Public Integrity, a nonprofit, nonpartisan investigative news organization in Washington, D.C. Former CIGNA executive-turned-whistleblower Wendell Potter is writing about the health care industry and the ongoing battle for health reform. Potter is the author of “Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care” and “Deceiving Americans and Obamacare: What’s in It for Me? What Everyone Needs to Know About the Affordable Care Act.”

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