HEALTH AND MEDICINE POLICY RESEARCH GROUP
Testimony before the CCHHS Board of Directors
Good Morning, my name is Margie Schaps and I am the Executive Director of the Health and Medicine Policy Research Group, a nearly 30 year old independent health policy research and advocacy organization committed to improving health systems and health status in our region. As most of you know, Health and Medicine has been committed to strengthening the public sector health system with a particular focus on the
I am here today to comment in general on the strategic plan and vision you are here to discuss today and on the proposed CareLink plan to charge co-pays for clinical services and Pharmacy services to system users, requiring retroactive payment, and turning away patients who do not comply with billing requirements.
First, I want to say that Health and Medicine feels that this board has done an outstanding job in extraordinarily difficult times, even for the County health system. The problems you have faced and will continue to face run deep throughout the system and they will not be solved in a year or two or by a couple of years of balanced budgets. Vision of how we can help lead the transformation of the practice of medicine, continued commitment to the communities you serve, and the courage to fight for what is right is what the people of our county need from the leadership of the system.
The board must be forward looking, not backwards directed. No longer should inpatient hospitals determine the character of County Health Services. We suggest organizing around two operating divisions, one for hospital based services that would include inpatient and specialty outpatient personal health services and a second for community/public health services which would include a network of primary care centers, Cermak and public health.
We must be prepared for the reality that our area, like the nation as a whole, does not have the primary care capacity to meet the needs of increased populations with insurance under the new health care legislation. Significant fiscal challenges at the State level in addition to the fact that there will still be tens of millions of Americans (likely 3-400,000 in our region) without health insurance, the county system is likely to be further stressed in the next decade, not relieved by passage of the federal health reform legislation.
As you define your strategic plan direction, we urge you to have a clear vision of a world class comprehensive and fully integrated health system based in communities encompassing personal and population health. These services must be available to all regardless of ability to pay or legal status. The services must be delivered in a linguistically specific and culturally appropriate manner with dignity and respect by a workforce and leadership that reflect the communities served by the system. We believe the system must be based on community centered primary care and reviving the ACHN network as a network of Federally qualified health centers. We believe that the public system must be partnered with the private sector depending on the needs of the system, the most critical partners are other parts of the traditional safety net, particularly the FQHCs and the safety net hospitals.
Furthermore, we urge you to examine the possibility of fully merging the City of
While we are aware of and sympathetic to the need of the system to raise additional revenue, we have concerns about the universal co-pay system now being contemplated as the right approach to raising needed financial support for the system. The revenue generated by this plan will likely be insignificant and may have more significant negative consequences.
- With regard to co-pays for medications, a 2004 study funded by the federal Agency for Health Care Research and Quality found that increasing patients’ co-payments for prescription medications led to decreases in their use of eight classes of therapeutic drugs. A study in the Journal of Occupational and Environmental medicine in 2007 found that increasing co-payments after the patient has started on a medication was a predictor of early termination of the medication. And finally a study reported on in Health Affairs in January 2010 found that reducing co-payments on medications increased the chances that employees with chronic illnesses will take preventive medications.
- Second, With regard to co-pays for outpatient services, a study published in the New England Journal of Medicine in January 2010 comparing longitudinal changes in the use of outpatient and inpatient care between enrollees in Medicare plans that increased copayments for ambulatory care and enrollees in matched control plans and concluded that “raising cost sharing for ambulatory care among elderly patients may have adverse health consequences and may increase total spending on health care”. This was in a system, Medicare, with people of all income levels and where people we accustomed to paying co-pays already.
- Finally, as you contemplate this decision to implement a co-payment program, I would caution you about the impact this may have on the long term loyalty of your patients. As health reform unfolds and more people are eligible for Medicaid coverage, the County risks losing some of these newly insured people to other providers. A goal of the system over the next couple of years must be to create an environment that patients are committed to, whether they have insurance or not. I fear that instituting universal co-pays will provide another reason for people to leave the system when they are able.
Thank you for the opportunity to testify.
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