Schools are cutting back on physical education courses and after-school sports, meanwhile health care costs continue to rise. Here in Modesto, it can be hard to find a specialist without a two week, or two month, waiting list, and that’s if you can afford insurance. People aren’t machines, that can simply sit in a holding pattern until a new part is ready for them – they need help now.

Hospital prices rise rapidly:
California facilities charging far more than actual costs

[B. Calvan & P. Reese, Apr. 19, 2010]

Behind every public uproar are some hidden facts. Here’s one about rising health insurance rates in California: Sharp jumps in hospital costs are a big part of the story.

Hospitals are charging insurance companies, and by extension their customers, billions of dollars for expenses not directly related to care. These include new hospital wings, new technology and services for the uninsured.

Sacramento-based Sutter Health has negotiated rates with “markups” more than double what it costs them to provide services. Memorial Medical Center and Sutter Gould Medical Foundation in Modesto are part of the Sutter Health system.

Hospitals say their charges to insurers are justified and necessary. Under law, hospitals must report the total amount of money they spend to provide services to insured patients each year, how much they bill insurance companies and how much they wind up collecting.

Based on those numbers, California hospitals charged insurers 53 percent more than what they told the state it cost them to provide services. In 2005, the gap was 40 percent.

Sutter Health has faced scrutiny for its pricing practices. Five years ago, Cal-PERS, the state’s largest buyer of health services, forced one of its key insurers to drop 13 Sutter Health hospitals from its stable of providers because CalPERS deemed the Sutter facilities too expensive.Insurers and hospitals negotiate discounted rates, and hospitals have different price structures for each insurance network they decide to join. In some cases, hospitals have blocked efforts to shed more light on their pricing policies. Revealing the information, they say, could reduce competition in the industry.



And for those who do not currently have health insurance, the new health care system overhaul will have a profound impact – with a few glitches. Are we willing to let virtual doctors take care of our needs? Are we comfortable with computers playing a central role in our health care?

Many in Stanislaus County lack insurance, on government plans

By Ken Carlson, Mar. 23, 2010

In approving an overhaul of the health care system, Congress seemed to write a prescription for a place like Stanislaus County, with its large numbers of residents who are uninsured or in government health programs.

The federal government, starting in 2014, will offer subsidies to help families and individuals buy affordable health insurance and will expand the federal and state Medi-Cal program now serving almost 124,000 county residents.

Some county health-care providers praised the bill, saying it will provide security for consumers and expand the base of patients able to pay for medical care.

Some predicted, however, a shortage of doctors to serve the newly insured.

Dr. Amarjit Dhaliwal, a cancer specialist in Modesto, praised the section of the bill that will prevent insurers from dropping or rejecting patients who have ongoing medical conditions. He said he has seen women with breast cancer dropped from insurance coverage in the middle of treatment. “That is not going to happen any more,” the oncologist said.

The California Primary Care Association, representing more than 800 community health centers in the state, believes the Medi-Cal expansion will add 1.7 million people to the health program, and an additional 2 million to 3 million will buy health insurance.Carmela Castellano-Garcia, the group’s chief executive officer, said the impact on the Central Valley will be profound, although the region’s undocumented population won’t be able to buy subsidized insurance.

Besides giving Medi-Cal benefits to childless adults for the first time, the bill includes $9.5 billion to help community health centers expand services and hire health care providers. An additional $1.5 billion is set aside for paying the education loans for new doctors agreeing to work in medically under-served areas such as the San Joaquin Valley.



There are many people who can’t wait for the new health care overhaul to go into effect, and many more who will need to stay as healthy as possible until it does.



HEALTH CHALLENGE

  • LEARN – Educate yourself about how to live a healthier lifestyle.  Expand your vision, and learn about how you can make Modesto into a healthy active community, perhaps through something as simple as walking.
  • ACT – What can you do about it? What one change can you make to help improve the healthy options available to your community? Using any one of your own self-described super powers, find another Super Hero and create a Healthy Alliance, and make that one healthy change TOGETHER! You can create your alliance with any currently active Super Hero, or you can invite someone to join the //Building Imagination Hero Alliance.
  • IMAGINE – Unleash your creativity. Imagine your Healthy Alliance has grown by 500 members. Tell me how you and your expanded alliance creatively transformed the healthy lifestyle options for others in Modesto through your videos, images, and blog posts and post a link to them in the comments below.
  • Ask A Mentor for Help


What do you think of this mission?
Easy to accomplish (3) Needs doing - but how to start (4) Too hard to do alone (1)


Blossoming Heroes:

Adouchi | Fierce Dreamer | Monkey Woman | Supermom | Healzor