European Stars And Stripes (Newspaper) - November 2, 1988, Darmstadt, Hesse                                Magazine  is i frs seem being braised from his carts a wamn6 6crverhmewr Van is fax ably Beir  mewgm3 to rats . Cost squeeze on America s hospitals by Isabel Wilkerson new York times a Cross the United Stales,.small Community hospitals indoor inner cities appear to Beon lha Brink of failure squeezed by fluctuations in state and Federal medicaid. Reimbursements and a Rise in indigent patients depending on ilium. These hospitals which Are privately run and Serva a Spee Ilic Community Are often the Only place where poor residents can get routine medical care. But now financially troubled themselves some of these hospitals Are barely Able to provide even marginal service. At the Roseland Community Hospital struggling to slay open on the South Side of Chicago the cat scanner broke Down for he fourth Tima this year. Once again officials had to Transfer patients to another Hospital knowing they could not Alford to replace a machine that was used when it was bought. V Roseland s troubles underscore the Dilli curly of running a Hospital in a Community that itself is falling apart. With 162 Beds Roseland is the Only Hospital in a densely packed 40-Square-Milo Swath of inner City  neighbors Are ramshackle taverns on 111 the Street where the Community s Many unemployed residents watch the world from the sidewalk in their Kitchen chairs. We re not like other communities where you look put the window and see live other hospitals said Oense Williams president and chief executive officer of Rossland for the poor people in this Community we re All they  but As the Community has declined in the Asl decade from a Middle class. Neighbourhood to a poor and working class one peppered with boarded up bungalows so have the fortunes of the Hospital. Like Many other Small inner City hospitals Roseland is trying to stave off Bill collectors and fix equipment that Breaks Down frequently at a time when ii is anxiously trying to attract better Oil patients whose insurance can pay for the Hospital s services. The Fate of hospitals like Roseland is a major concern of health policy experts who say that without these hospitals poof americ ticks May have dangerously limited Access to health care. A shortage of inner City hospitals could result in even lower life expectancies and higher Inland mortality rates for the poor it s a double barrelled problem said one of the experts Alexander Williams Iii senior vice president of the american Hospital association. Many of these hospitals Are not the kind i hospitals that would attract people poor or not from outside the Community. The High / Cut socially difficult and unpopular patients Are the ones they re caring for. They Are Likely to have no full pay patients and a Large number of patients who Are unable to pay at All.". Last year a record 79 of the nation s 5,000 hospitals closed across he country while few if any. Opened. About half of those hospitals that closed were in. Inner lilies. Indigent patients Many i Thern uninsured Are overloading a shrinking number of hospitals already financially strained by rising costs.1 unable to pay Lor routine visits to a doctor they usually show up at emergency rooms sicker than other patients requiring costlier procedures. In Illinois 80 percent of the slate s medicaid patients Are concentrated in 20 percent of the slate s 238 hospitals. Virtually All of those strained Community hospitals Are in the Low income neighbourhoods of Chicago and East St. Louis. At 28 of those hospitals Roseland included. 27 percenter More of the patients Are on medicaid according to the Illinois Hospital association opposed to 12 percent at a typical Illinois Hospital Many of these hospitals lace almost certain death. Either these hospitals Are going to close or they re going to change their Mission said Gerard Anderson director of the Canter Tor Hospital finance and management at Johns a opens University in Baltimore. If you re storting to have More than 25 percent medicaid you re in  at Roseland nearly 90 percent of its 6,000 patients each year Are either uninsured or assisted by Public Aid from the state or Federal government including 50 percent who Are on medicaid. The Hospital loses Money on almost every patient it admits because medicaid in Illinois pays a Flat per Odiern rate rate which is Well below the Cost of treatment.-."."". Before the Early 1980s, when medicaid generally reimbursed hospitals based on expenditures hospitals were virtually assured of breaking even. Now Many states seeking to contain costs Are Basing their payments on either. Standardized limits Lor certain diagnoses or As in Illinois and California a set number of Days or which the state will. Reimburse hospitals that care Lor medicaid  hospitals say the changes Are pushing them toward bankruptcy but state health officials say Many troubled hospitals Are merely being mismanaged. Our program is not intended to keep hospitals in business but to buy Quality care Lor poor patients said Martha Thompson chief of the Bureau of Hospital services at the Illinois. Department of Public Aid. Citing an average occupancy rate of 60 percent in the City s hospitals Thompson asked it a Hospital has Only one patient should we pay $10.000 a Day for the Hospital to meet its operating costs but Hospital administrators say hut efficiency alone does not make up for the a Jug a uninsured patients seeking care for which the hospitals got no compensation. Adjusted Lor inflation hospitals across the country lost $7 billion caring Tor indigent patients in 1986, More than twice the $2.8 billion lost in 1980, according to Tho american Hospital association. In 1936, at least 31 million people and perhaps As Many As 37 million had no private or Public a ally insurance according to the Federal census Bureau. Complicating the problem Tor hospitals heavily dependant on medicaid Are lha delays and instability of Many state programs. Last Spring Illinois like several other slates ran out of Money Lor medicaid and. Except for sporadic emergency Aid to the neediest hospitals halted medicaid reimbursements for nearly three months. There were immediate repercussions. The Day the suspension was announced Mary Thompson Hospital a 203-bed West Side facility with 60 percent of its pallets on Public Aid announced in was shutting its doors. Last month Chicago s Frank Cuneo Hospital where 88 percent of the patients were on Public Aid closed. Ii was losing $2 million a year. These hospitals have Tittle elasticity something happens and the hospitals living close to the Edge can easily go under said a spokesman for Williams of the american Hospital association. It is a trend playing out All Over the country. Last tall when West Virginia halted medicaid payments Lor six months one Hospital closed several stopped admitting patients and Many others came close to bankruptcy. What we re seeing is the cumulative effect Oll Osses said Alan Sprintz executive senior vice president of the Chicago health care Council an association of about 34 Chicago hospitals it s1 u incl Hiort of what has happened Al Rural hospitals. Now a lot of inner City hospitals Are culling stall and services."-. That is what Roseland did. To make up for an operating loss of nearly $1 million Over the last two years the Hospital has Cut 100 staff positions eliminated unnecessary supplies and now v periodically closes Ijo ors. For years Roseland was the butt of. Jokes among Community residents who used to say thai it they Ever were in an automobile Accident Roseland was the last place they wanted to go. Now that the Hospital has fallen on hard times lha 70,000 people in the Roseland area remember the limes it came through like when children at the Grade school came Down with food poisoning East year and were taken la the Hospital five minutes.  year he arid other Community leaders went to a local Bank and got approval for a line  for the Hospital to tide in Over still when Illinoisan  medicaid Money this year and Roseland had logo Hearty Lour months without a regular medicaid payment the Hospital used Money it had earmarked for new equipment to cover immediate expenses and slopped paying most of its Bills ii did so despite an emergency payment of $647,000 from the state. Wednesday november 2, 1988 the stars and stripes Page 13