Econ 30500 – Economics of Poverty
Professor Warlick
Claire Anderberg, Jaime Dennig, George Fisher, Eileen
Offer, Oscar Padilla, Sharon Zhu

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How do Indiana State programs help alleviate financial stresses?
Economic burden to Memorial Hospital
How are hospitals reaching out to the community?
Health care for extreme poverty
Health care on campus

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Non-elderly Americans (65 and under) w/o health insurance increased 10% from 2000-2002 to over 44 million (17% of population)
Over 49,500 uninsured in St. Joseph County
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Increases in uninsured have been linked to employers dropping health care coverage and increasing costs of health care coverage
The uninsured do not come from one social, economic, or racial class
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They come from all walks of life
“Cover the Uninsured Week” – report by Ann Thompson athompso@co.st-joseph.in.us

“Only questions with more than 50 respondents are included in the county profile, as a sample less than 50 would not provide statistically stable results. Due to the relatively small size of the SJC sample (236 respondents), analysis based on age, race and sex could not be completed”.
http://www.stjosephcountyindiana.com/sjchd/PDFs/St.%20Joseph%20County%20Health%20Department%20
-%20Health%20Assessment.pdf

http://www.stjosephcountyindia
na.com/sjchd/PDFs/2006Annual
Report.pdf

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CKF (
Covering Kids and Families of St. Joseph County
) helps families in the process of applying for health care aid through “Hoosier
Healthwise”
Goal of CFK is “to ensure that all eligible families have access to affordable healthcare”
There are many different places around
South Bend that to go for help in enrolling for Hoosier Healthwise http://www.ckfindiana.org/index.html
http://www.ckfindiana.org/st_joseph/enrollment.html

SCHIP and Medicaid of Indiana
Who’s Eligible - “children, pregnant women, and low-income working families” – Must meet income requirements
(150% of poverty level)
How do they receive health care? – Each family is assigned a PMP (primary medical physicians). The program provides you with a list of doctors to choose from in your area
- PMP must be picked within 30 days of beginning the program, and you must maintain a PMP for 12 months unless you supply “good cause”
- Choose a Managed Care Organization
- You can only receive care from within your MCO http://www.in.gov/fssa/maternal/hoosier_healthwise/whoiselig.html
http://www.in.gov/fssa/maternal/hoosier_healthwise/getcare.html
Interview with David Roos (Vice President St. Joseph County Health Department droos@ckfindiana.org
)

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- Emphasis on preventative care and check-ups
There are different packages available
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Ex. Package A includes – hospital care, doctor visits, check ups, prescription drugs, lab services, substance abuse services, mental health care, dental care, vision care, transportation, chiropractors, etc. at NO COST
Package C offers the same services but with co-payments for prescription drugs and limited other services (151%-200% of the poverty level – not the poorest)
All payment goes directly to the health care providers and not to the families enrolled
-Pay premiums with SCHIP but not with Medicaid http://www.in.gov/fssa/maternal/hoosier_healthwise/benefits.htm
Interview with David Roos (Vice President St. Joseph County Health Department droos@ckfindiana.org
)

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Participants in the Hoosier Healthwise system are told to contact their PMP first
If the doctor is not in but can speak with the patient, the doctor will further direct them
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In the event of an immediate emergency they must go to the hospital and contact their PMP from the hospital
(the use of the PMP is to hopefully prevent emergencies by using preventative care) http://www.in.gov/fssa/maternal/hoosier_healthwise/benefits.html

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Activity (1/1/2005–1/1/2006)
Admissions:
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18,158
Inpatient surgeries:
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4,912
Outpatient visits:
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157,043
Outpatient surgeries:
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8,720
Emergency room visits:
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48,527
Births:
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3,251
Number of beds:
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325
 http://www.usnews.com/usnews/health/hospitals/directory/numbers_6421290.htm

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Methods
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Scoring hospitals on a set of weighted performance measures centered on clinical excellence, operating efficiency and financial health, and responsiveness to the community:
Risk-adjusted mortality index
Risk-adjusted complications index
Risk-adjusted patient safety index
Core Measures Score
Severity-adjusted average length of stay
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Expense per adjusted discharge, case mix- and wage-adjusted
Profitability (operating profit margin)
Cash to total debt ratio
Growth in patient volume
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100 Top Hospitals: National Benchmarks for Success —
2005 http://www.100tophospitals.com/default.aspx

Allocation of Dollars and Persons Served under Adopted Charity Policy
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Most nonprofit hospitals adopt a charity benefit policy to serve the medically indigent. On an annual basis, the hospital will confirm the eligibility and set aside dollars to ensure low-income persons can be offered needed inpatient and outpatient hospital services.

Allocation of Dollars and Persons Served under Adopted Charity Policy
2001
Persons served in the last 12 months
2,321
Charity Care
Allocation
2002
2,181
2003
2,799
$1,406,977 $1,477,122 $1,939,266 http://www.in.gov/isdh/regsvcs/acc/fiscal03/005053.pdf

Unreimbursed Costs of Charity Care,
Government
Funded Programs, and Community
Benefits
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Based on uniform definitions of costs, each nonprofit hospital must identify the costs of serving its community that are not reimbursed by government and other third party payers.

($2,388,068) Total unreimbursed costs of providing care to patients unable to pay, to patients covered under government funded programs, and for medical education, training
Community Health
Education
Community Programs and
Services
Other Unreimbursed Costs
0
($1,743,845)
($1,196,700)
Total Costs of Providing
Community Benefits
($5,328,613)
• http://www.in.gov/isdh/regsvcs/acc/fiscal03/005053.pdf

2003 2004 2005
Net Patient service revenue
Provisions for bad debt
Percent of total
$313,328 $335,189 $364,300
16,436
5.24%
18,341
5.47%
23,716
6.51% http://www.qualityoflife.org/aboutus/publications.cfm

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Payment plans if possible.
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Collect as much as possible if continued procedures are needed.
Discounts on procedures.
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Collect as much as possible all things considered.
Refer to various help agencies.
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Religious groups, clinics, etc.

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Established in 1882 by the Sisters of Holy
Cross
Center’s Mission: To serve together in
Trinity Health in the spirit of the Gospel to heal body, mind and spirit to improve the health of our communities, and to steward the resources entrusted to us.

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Michelle Peters: Director of Outreach
Services
Outreach Programs offer primary and educational services to community members in St. Joseph and Marshall
Counties.
Established to serve the un-insured, under-insured and Medicaid populations in both counties.

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Sister Maura Brannick Health Center –
South Bend
Healthy Family Center – Mishawaka
Family Medicine Center – South Bend
St. Joseph’s Urgent Care Center
Mobile Medical Unit

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Established in December 2005
40 Foot Long “Clinic on Wheels”
“We welcome any opportunity to help those without healthcare simply because they have no way of coming to us. I am proud to say that with the Mobile Medical Unit, we are coming to them.” Nancy Hellyer, St. Joseph’s Regional
Medical Center Chief Executive Officer.

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Staffed by a Family Nurse Practitioner, mammographer, and intake coordinator.
Services Provided: Mammograms, physicals, women’s health, health screenings, minor illness, health maintenance

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Areas the MMU Serves:
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West Side of South Bend (2 Days)
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Mishawaka (1 Day)
Plymouth (2 Days)
Amish Country (Every 3 rd Friday)
Schedule on the website shows where the
MMU will be every day of the month:
 http://sjmed.com/PDF/MMU_2007_April_Schedule.p
df

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Struggle to spread awareness of these programs.
Trying to get more recognition out there so that the community knows that St. Joe is doing all of this.
Patients are missing their preventative care because they are unaware of these programs

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St. Joseph’s and Memorial have begun collaborating their efforts through advertisements and funding
Local Businesses and Media are working to spread the word as well

What happens to a person who is unable to purchase medical insurance and is ineligible for Medicare or Medicaid?
The Sister Maura Brannick Health Center
Chapin Street, South Bend
•Sponsored by St. Joseph Regional Medical Center
•60 Volunteer Doctors from the South Bend/Mishawaka Area
•Multilingual Staff including Social Workers and Financial Counselors
•Onsite Dental Clinic
•$5 Co-pay covering all services and medication

To become a patient:
•Application involving financial screening
•Necessary criteria:
-Ineligible for Medicaid or Medicare
-Unable to obtain health insurance
-Must be 150% below the government established poverty line.
-Can not be a patient at another clinic
•All patients are assigned a primary care doctor.

Services at the Health Center
Preventive healthcare.
•Treatment for acute injuries or illness.
•Chronic disease management.
•Screenings.
•Free immunizations for those who qualify.
•Head Start and school physicals.
•Prenatal and OB care.
•Drug Assistance Program w/pharmacist available.
•Nutritional and diabetic counseling.
•Dental clinic on site for general preventive and restorative dental care.
Any services that are necessary but not available because of a lack of equipment or any other reason at the Health Center are available at St. Joseph’s. Those such as eye specialists and ear nose and throat specialists are offered for free by the doctors of the St. Joseph Medical Center.

What happens in the case of an emergency?
•Patients are directed to St. Joseph’s Hospital for emergency care.
•Hospital bill is forwarded to the Health Center. The case is reviewed and in most instances the bills are covered.
•If a patient must be admitted:
-Financial Advisor helps the patient apply for HCI, a government program that will cover the cost of the stay.
If not accepted by HCI, St. Joseph’s Regional Medical Center absorbs the cost of the stay.
Information provided in an interview with Lilia Periquet, Social Work Coordinator (4/3/07) http://sjmed.com/svc_outreach_HC_SB.htm

~University health insurance (Megalife) is only mandatory for graduate and international students (undergraduates do not need to provide proof of insurance, they only need to call in August to remove Megalife from their billing account).
~Students are not charged to been seen by professionals at the health center, but supplies, medicines, procedures, labs, and x-rays
~All charges except for lab and radiology are billed directly to Student Accounts, they do not file claims
~An itemized statement will be given to the student or sent through campus mail for them to file with their insurance if they are not a part of Megalife.

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“All Notre Dame students are invited to use our medical services regardless of having private, school sponsored insurance, or no insurance coverage.” Ann
Elizabeth Kleva, RN, MSA, Director,
University Health Care Services

ND Health Services does not take care of payments for you
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The services listed below are the financial responsibilities of a patient:
• Laboratory tests
• X-rays
• Injections, including allergy shots
• Medications
• Medical supplies
• Medical procedures
• Consultations with physicians outside University Health Center
• Hospitalization and / or treatment at a community hospital or emergency room

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“The only insurance that we take is the
Notre Dame MegaLife Insurance, If you have private insurance, we will provide you with a detailed receipt for filing with your insurance company for reimbursement each time you receive a prescription. We can also provide a detailed statement upon request.”

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Deferred payment
Payment in installments
Rector funds (on a case by case basis)

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Not always what you expect
Small Business owners
Transitional workers
Divorced individuals
Single working males
Notre Dame students
College Graduates
This is not just a problem contained by a certain socioeconomic stratum, it encompasses people from all walks of life.