People are frustrated about the growing phenomena of hospital closings and the shutdown of health services. The hospital closure issue has grown from the purchasing of non-profits by for-profits, to large hospital systems shutting down their own facilities/services, to the closure of essential but underfunded hospitals in targeted neighborhoods. The decision makers say they have no choice because revenues continue to decline while costs increase, making financial insolvency is imminent.
The Essex County region is home to a large and growing racially and ethnically diverse population including immigrants, many who are medically underserviced, underinsured or uninsured with limited economic resources. Occasionally state government responds with a short-term, unsustainable bailout, while the few community/consumer leaders who do complain seem primarily interested in the loss of jobs for friends and family. They seldom highlight the loss of health services. Recent professional reports have shown the problems of health care costs are more intricate than advocates and providers are willing to admit.
For too long, New Jersey residents have endured an uncoordinated and disjointed approach to the delivery of health care. Currently, health care providers are forced to chase dwindling revenues. There is no coordinated collaborative planning among competing providers. Crisis management prevails: health services are eliminated or expanded based on the individual provider’s bottom line, with no consideration given to the health impact on the affected populations.
As nearby health services are closed, vulnerable populations are shifted to distant facilities, which are already overburdened. This is counter productive. Tremendous gaps in needed services occur in some neighborhoods, while an oversupply of specialty services occurs in others. Too often, distressed hospitals in poor areas are closed, while profitable hospitals in wealthier areas expand. This has resulted in fewer healthcare options or long waiting times for residents dependent upon Medicaid and Charity Care.
Competent specialists experience layoffs in urban areas, while new technologies are advanced in specialty centers located at inconvenient distances. In many healthcare settings in poor urban neighborhoods, paper patient records are the norm while interconnected state-of-the-art data/technology systems are used elsewhere. While disenfranchised communities complain, there appears to be few advocates demanding change. New Jersey must bring back local level collaborative health planning to protect our vulnerable populations.
In 2006 the Robert Wood Johnson Foundation and Blue Cross Blue Shield funded the Avalere Corporation to publish the New Jersey Almanac, which provided stakeholders with a reference document to help inform and frame the key, interrelated policy questions that will require resolution in the coming years.
In 2008 the New Jersey Commission on Rationalizing Healthcare Resources issued its final report, which included recommendations calling for a greater transparency on the cost and quality of hospital care in a form that facilitates comparisons with performance benchmarks and greater accountability for resources. Although these two reports are thorough in identifying problems and call for greater collaboration in healthcare delivery, they fall short in protecting safety-net populations, and on making recommendations for public participation to:
Engage New Jersey’s urban healthcare constituents in meaningful dialogue to understand the complexity and interrelatedness of the problems.
Encourage coalition building and advocacy among health providers, consumers and local governments.
Despite these daunting challenges there is a tremendous opportunity for the health providers in the region to be in the forefront of devising solutions to this bankrupt healthcare system while creating thoughtful dialogue.
We applaud the Essex County delegation members who brought together Congressional leaders, state legislators, CEO’s of Essex County area hospitals, state commissioners, directors of local health departments, community health centers and other healthcare providers to discuss the healthcare crisis.
The gathering called for the creation of a collaborative approach to the delivery of healthcare services for Essex County. Regional healthcare planning in the county and by the area healthcare providers is essential in order to create a healthcare environment that is cost effective, sustainable, and protects the region’s most vulnerable populations.
Essex County has some of nation’s best minds in urban health, health advocacy and healthcare service delivery and it is important that we in New Jersey develop a “Best Practices” healthcare model for transforming the urban healthcare delivery system.
George Hampton, Director, Healthcare Reform New Jersey Appleseed, also contributed to this column.