Our family got a new car last summer. We really needed it, but it was more costly than we thought. So we’re figuring out ways to save money.
If we just eliminate all those needless maintenance expenses, we think we can save a bundle. No oil changes. No new filters. No fluid checks. No new brakes. No exhaust system maintenance. The car may suffer, but hey, we’ll just sell it to someone else, and it will be someone else’s problem then.
What we wouldn’t do with a car, we consider standard operating proceedure in healthcare. Cost shifting and delaying care is the way the game’s played.
Sometimes, those healthcare decisions are conscious, while other times they appear to be unintentional or just not well thought out.
We’re covering a couple of those stories in this issue. In one, the need for proof of citizenship is having a chilling effect on the growing movement to provide health coverage for uninsured children through State Children’s Health Insurance Programs.
A study by the Kaiser Commission on Medicaid and the Uninsured showed some positive strides, but it found that 74 percent of eligible uninsured children from low-income families are not enrolled in programs that would give them essential health coverage.
Requirements from the Deficit Reduction Act of 2005 have raised barriers for families, especially those who may not have the right documentation to submit during the application process. It’s believed that these requirements are limiting the number of immigrants who otherwise might apply to Medicaid for coverage.
Of course, the issue of immigration is particularly contentious and political, but the argument can be kept simple in the healthcare arena – people will need care, and treating uninsured people tends to be more expensive than treating those with coverage, for a variety of well-known reasons.
It’s not that people without proper documentation won’t have health issues, because they will. The problem is that once they receive treatment, healthcare organizations face a high likelihood of providing treatment without compensation from any program that could provide coverage.
There’s additional systemic cost when people delay treatment until their conditions are serious or when they seek care in high-cost settings after their conditions have worsened. Pennies saved early on are overwhelmed by the dollars lost later downstream when care is more involved and more expensive.
The same can be said of efforts to treat childhood obesity. It’s a significant national problem, with recent research indicating that 16 percent of U.S. children could be considered obese. While an analysis of data by Thomson Medstat indicates that this diagnosis is appearing more frequently on claims, only 0.2 percent of the nation’s children are being treated for obesity.
Obesity represents immediate healthcare costs, because the care for children diagnosed with it is roughly three times as expensive as the average insured child. And there are downstream costs for lack of treatment, as these children grow into adults with expensive chronic conditions such as musculoskeletal disorders, diabetes and heart disease.
It’s also a national concern because children covered by Medicaid are more likely to be diagnosed with obesity, and their care is probably going to be two to three times as expensive as the care of someone covered by private insurance.
It’s important to look not when a physician diagnoses a patient with obesity. That medical concern has its roots much earlier on, and it’s exacerbated by poor diet choices and options often associated with those in lower socioeconomic settings.
Restraining future healthcare expenditures, then, are dependent on expenditures, both healthcare and non-healthcare, made early on to intervene in individuals’ lives before they are afflicted with illnesses that will saddle them with debilitating illnesses and the system with large future expenses for care.
In a cash-strapped economy where we already spend $1.9 trillion on healthcare, it’s easy to get “penny wise” about spending now, this year, without taking a longer view of the eventual cost to the system and society. It’s time to start paying more attention to the “pound foolish” part of the equation.