Since uninsured patients can’t afford to see a doctor or partake of preventive treatments, they typically end up in costly emergency rooms for their primary care. According to the Oregon Association of Hospitals & Health Systems (OAHHS), the state’s annual number of emergency room visits rose 5% between 2007 and 2011, and outpatient visits rose 15%. Inpatient days — when a doctor has ordered a patient to be admitted — fell 3%, with fewer inpatient admissions and shorter lengths of stays. With 320 ER visits per 1,000 people in 2010, Oregon fared better than 42 other states, but, unfortunately, many of these visits are on the house.
When hospitals deem a patient unable to pay, they provide “charity care,” which ballooned nearly 600% in the decade ending in 2011. “Bad debt,” hospital bills that patients refuse to pay, rose almost 150% in the same period. Together charity care and bad debt comprise what hospitals call “uncompensated care.” In Oregon’s urban areas, uncompensated care approached 8% of gross charges after the last recession — it neared 9% in Oregon’s rural hospitals — before improving in 2011.
To make up for these losses, hospitals can’t look to government programs. Medicare pays just 81 cents, and Medicaid 86 cents, for each “dollar spent caring for beneficiaries,” OAHHS claims. So ultimately, hospitals must balance budgets by “cost shifting” losses and deficits to the bills of private-insurance patients. In the end, lowering hospital bills will require tackling enormous twin challenges of bad debt and charity care.
SOURCE: OREGON INSURANCE DIVISION
SOURCES: OREGON INSURANCE DIVISION, OAHHS, OREGON EMPLOYMENT DEPT.