The University in
American Life:
The University
of North Carolina
Health Care System
October 31, 2005
The UNC Academic Health Center Today
An integral part of the University of North Carolina at Chapel Hill
Does a University need
a Teaching Hospital?
If yes, then why?
The Context of Health Care
within the University
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The health care system, like the University, is a
reflection of the society in which is operates.
Health services have changed rapidly in the last 50
years, and the UNC Health Sciences Center reflects
that change.
The service role of university-based teaching hospitals
is essential to the growth of educational and research
programs on the part of the health science faculty.
We will consider the evolution of UNC Hospitals and
the UNC Health Sciences Center in that context.
The University in American Life:
The 1940’s and 1950’s
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High rate of young North Carolina men not medically
eligible for the draft - rejected from military service in
WWII. Good Health Movement formed.
Increased awareness of the lack of health services in
North Carolina - especially in rural areas
A rapidly growing nation - health manpower shortages
Emerging expansion of health insurance programs
“Hill Burton” funded hospitals developed with a
community service obligation
The University’s Response:
History and Evolution
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UNC School of Medicine
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North Carolina Memorial Hospital – 1952
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Named as a memorial to North Carolinians who died in all wars
Name changed to UNC Hospitals - 1990 – also kept the NCMH
NC Memorial Hospital separated organizationally from the
administration of UNC-Chapel Hill - 1971
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2 Year School - 1879
4 Year School – 1952
Board of Directors established
UNC Health Care System Formed - 1998
The University in American Life:
1960’s & 1970’s
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Medicare and Medicaid programs established
as part of the “Great Society” (1965)
–
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Increased access to health care by the
“underserved” who were generally the poor and
minority populations
Improved access to outpatient services and
new markets for hospitals
Continuing health manpower shortages
Significant growth in NIH research funding
The UNCHCS Response:
Focus on Mission
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The Mission of the UNC Health Care System is
to:
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Provide high quality patient care
Educate health care professionals
Advance health and biomedical research
Serve the community
Unique Qualities of UNC Academic
Health Center for North Carolinians
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UNC is the only University in the State of North
Carolina to have all 5 health sciences schools and a
major teaching hospital on one campus:
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Medicine & Allied Health
Public Health
Nursing
Pharmacy
Dentistry
Key links to other schools on campus, and multiple
Centers, Institutes and Programs that provide both
research and service
Recognition of a state-wide role in health services
AHEC* Primary Care Training Sites
for Medical Students, Physician Assistants,
and Nurse Practitioners
Medical Student
Physician Assistant
Nurse Practitioner
* AHEC = Area Health Education Centers
North Carolina Area Health Education Centers
(AHEC) Program
Locations of Continuing Education Programs, 2004-2005
Mountain
Greensboro
Coastal
Northwest
Southern Regional
Area L
Charlotte
Wake
Eastern
AHEC Continuing Education Programs
Source: NC AHEC Program
The University Academic Health
Center Environment: 1980’s
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Increasing scrutiny of the cost of health
services
New payment schemes to control costs
Concerns about an “appropriate” number of
health professionals
Increasing regulatory environment in health
planning, service development, and quality
–
Certificate of Need, Accreditation, Peer Review
Agencies
The University’s Response:
School of Medicine
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Between 1970 and 1980 the number of medical
students grew from 340 to its current size of 640
students and faculty grew accordingly
5,983 medical degrees awarded since the first class in
1954
Allied Health Sciences Enrollment in 2005 of 369
students (laboratory science, occupational therapy,
physical therapy, radiologic science, speech and
hearing, etc.)
Major growth in research faculty and facilities to
support their efforts that continues today.
NIH Support to U.S. Institutions
of Higher Education
Fiscal Year 2004
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Johns Hopkins University
University of Washington
University of Pennsylvania
UC-San Francisco
Washington University
University of Michigan
UC-Los Angeles
University of Pittsburgh
Duke University
Harvard University
Yale University
UC-San Diego
Columbia University
Stanford University
UNC-Chapel Hill
University of Wisconsin
Vanderbilt
599,151,309
473,432,138
464,076,925
438,778,831
388,307,875
368,176,446
361,593,433
360,635,035
343,825,304
325,665,202
323,614,091
304,039,410
303,714,701
301,733,744
289,652,932
264,059,408
251,147,207
The Academic Health Center
Environment: 1990’s
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Rapidly changing health insurance market moving from indemnity
services to “managed care”
Increased emphasis on cost & questions about what quality health
care might be
Increasing consumerism - with attendant demands and
expectations (patient’s rights)
Continued growth in challenging biomedical research
Recognition of the special role of Academic Health Centers and
their societal contributions
– Managed care entities wanted to use our “products”, but didn’t
want to pay for them
The UNC Health Care System
Today
Profile
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A system providing outpatient, inpatient, urgent, and
emergent care
A comprehensive health center, providing services
from wellness and preventive programs to organ
transplants
Includes other owned or affiliated hospitals, home
health and hospice services
A community partner with other health care agencies
and services
A laboratory for teaching, and a place for clinical
research
A public facility, with societal obligations
The UNCHCS Vision
To be the nation’s leading public
academic health care system
Leading. Teaching. Caring.
Special Features
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The first hospital in the country to provide intensive
care services
The only comprehensive burn center in North Carolina
(between D.C. and Atlanta)
A place where cutting edge research links to service
– Breakthrough treatments in hemophilia, respiratory
diseases, cystic fibrosis, gene therapy, AIDS,
Cancer, and others
Serves North Carolinians of all walks of life
–
70,000 babies born since 1952
University of North Carolina Hospitals
FY 2005 Inpatient Origin by N.C. County
Total Discharges: 31, 334
Ashe
Watauga
Alleghan
y
Surry
Northampton
Wilkes
Yadkin
Stokes
Avery
Rockingham Caswell
Forsyth
Mitchell
Person
Yance
y
Burke
Haywood
Swain
Buncombe
Edgecombe
Martin
Davidson
Washington Tyrrell
Wake
Chatham
Randolph
Wilson
Catawba
McDowell
Rowan
Pitt
Johnston
Lee
Beaufort
Greene
Rutherford
Jackson
Macon
Cherokee
Bertie Chowan
Davie
Lincoln
Graham
Halifax
Nash
Durham
Alexand
er
Iredell
Gates
Hertford
Franklin
Orange
Guilford
Caldwell
Madison
Granville
Warren
Vance
Henderson
Polk
Transylvania
Clay
Cabarrus
Cleveland
Gaston
Montgomery
Stanly
Harnett
Wayne
Moore
Lenoir
Craven
Mecklenburg
Pamlico
Cumberland
Union
Anson
Richmond
Hoke
Jones
Sampson
Duplin
Onslow
Scotland
Robeson
Bladen
Pender
LEGEND
10-99 cases
1-9 cases
100-249 cases
250-999 cases
UNC Hospitals
1000+ cases
Columbus
New Hanover
Brunswick
Carteret
Hyde
Dare
University of North Carolina Hospitals - Distribution of
Non-Reimbursed Care
(by County of Residence – North Carolina)
FY 2005
Camden
Alleghany
Northampton
Ashe
Watauga
Surry
Wilkes
Stokes
Rockingham Caswell
Iredell
Rutherford
Jackson
Macon
Henderson
Polk
Nash
Chatham
Wilson
Pitt
Rowan
Johnston
Lee
Cabarrus
Stanly
Cleveland
Martin
WashingtonTyrrell
Wake
Lincoln
Graham
Cherokee
Catawba
McDowell
Perquimans
Chowan
Bertie
Franklin
Edgecombe
Davidson Randolph
Currituck
Pasquotank
Halifax
Davie
Burke
Swain
Orange
Durham
Caldwell
Madison
Buncombe
Hertford
Vance
Guilford
Avery
Haywood
Person
Yadkin
Forsyth
Yancey
Gates
Warren
Harnett
Wayne
Moore
Beaufort
Greene
Gaston
Craven
Lenoir
Clay
Union
Anson
Hoke
Cumberland
Pamlico
Sampson
Duplin
Jones
Onslow
Carteret
Robeson
Bladen
Pender
Columbus
New Hanover
Brunswick
Legend for Map
< $500,000
$500,000-$1M
$1M - $3M
> $3M
Source: Actual 2005 charity and bad debts by residence of patients treated – UNCH’ Fiscal Services
Hyde
Dare
Key Statistics - Fiscal Year 2005
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31,322 Admissions
202,048 Inpatient Days of Care
Average Length of Stay – 6.4 Days
680,689 Outpatient Physician Visits
– Includes 198,091 in off-campus sites
65,894 ER, Urgent Care and Peds ER Visits
253 Transplants (heart, lung, kidney, bone marrow,
liver, pancreas)
1117 Air Transports
3,574 Babies Delivered
UNC’s Clinical Support for Educational Programs
22% of active North Carolina Physicians Trained
at UNC Hospitals or UNC
Percent of Active Physicians Trained by UNC/UNC-CH
North Carolina, 2004
Alleghany
Ashe
Surry
Stokes
Gates
Rockingham Caswell Person
Warren
Hertford
Watauga
Halifax
Wilkes
Yadkin
Avery
Guilford
Caldwell
Henderson
Jackson
Cherokee
Clay
Macon
Nash
Edgecombe
Iredell
McDowell
Catawba
Rutherford
Polk
Davidson
Burke
Swain
Graham
Bertie
Franklin
Davie
Madison
Buncombe
Forsyth
Lincoln
Randolph
Wilson
Rowan
Gaston
Stanly
Cleveland
Johnston
Lee
Cabarrus
Martin
Wake
Chatham
Pitt
Moore
Wayne Lenoir
Craven
Hoke
Sampson
Anson
Jones
Duplin
Onslow
Total % of UNC Physicians in North Carolina =
Hyde
Beaufort
Greene
Harnett
Robeson
UNC / UNCH trained physicians* =
Dare
Pamlico
Union
Total Active Non-Federal Physicians =
Tyrrell
Bladen
17,349
3,794
22%
*Combines UNC graduates and UNCH residents in an unduplicated count.
Produced by: North Carolina Health Professions Data System, Cecil G. Sheps
Center for Health Services Research, University of North Carolina at Chapel Hill.
Sources: Alumni Affairs Data, 2004, and North Carolina Health Professions Data System, Cecil
G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 2004.
Pender
Percent of Physicians Who Trained at UNC-CH
Columbus
New
Hanover
Brunswick
Carteret
(# of Counties)
All Physicians Trained at UNC (2)
60.0% to 99.9%
(3)
30.0% to 59.9%
(13)
15.0% to 29.9%
(44)
5.3% to 14.9%
(33)
No UNC-Trained Physicians
(5)
*Physicians included are active, instate, nonfederal, non-resident-in-training.
UNC/UNCH trained 31% of the MDs in the 10 counties with the fewest MDs
UNC Health Care System - Formed 1998
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What is it?
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An integrated health care system, owned by the State of North
Carolina and based in Chapel Hill.
Who is it?
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UNC Hospitals and the practice plan of the School of Medicine
were combined into a single system, with a single CEO
The UNCHCS was given management flexibility in purchasing,
consultation, construction, and human resources activities to
assure its management flexibility and competitiveness in a
rapidly changing health care business environment.
UNC Health Care System
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Why create it?
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How is it governed?
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More responsive to the “marketplace”, blending the cultures of
the academic base with the marketplace
Allowed for needed flexibility from State management systems
A Board of Directors is appointed by Board of Governors of
University of North Carolina System, upon recommendation of
the President
Board includes state-wide community representatives and
representatives from UNC- Chapel Hill, UNC Hospitals, and
the School of Medicine
What is it?
–
UNC Hospitals, Rex Healthcare, Home Health
and Hospice, etc.
The UNCHCS in Year 2005 and Beyond
in Health Care’s Challenging Environment
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Increasing demand for services versus declining
payment and increasing costs
Staffing shortages – especially registered nurses
Challenges in resource allocation and in priority setting
for program development
Capital program growth and development
Heavy and costly regulation
Significant emphasis on quality improvement and
patient safety
And on the UNC campus …Parking, Parking, Parking
Positioned to Face the Challenges
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New facilities developed and in planning
Strong support for health science education
Flexibility in response to human resource
issues
Severe financial challenges ahead
? Parking, parking, parking…….
Growing interface between patient care and
research
Carolina Roadmap to Success
Multidisciplinary and Collaborative Research
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The National Institutes of Health have devised a new,
very competitive, Roadmap program.
Program is designed to transform the nation’s medical
research capabilities and speed research discoveries
from the bench to the bedside.
Carolina garnered 8 of these prestigious grants – more
than any other institution in the nation.
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Vanderbilt and Columbia - 6
Memorial Sloan-Kettering Cancer Center - 5
Johns Hopkins - 4
Harvard and Stanford - 3
Duke - 2
The Hospital and the University
Parallel Universes
Policy & Program Opportunities
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Development planning and coordination
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Infrastructure development and support
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UNCHCS Facility Master Plan in University
Development Plan
Adjacent facilities and future growth potential
Parking subsidies and utility development
Community relations
Program development and growth
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University Child Care Center
Ronald McDonald House & Family House
Day-to-Day Operations :
Mission Focused
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Educate new health professionals and offer
young people opportunities for growth
Serve people statewide through the patient
care provided and constantly developed while
also educating and learning new things
Provide a laboratory for clinical research done
by the health science schools with care for
protection of patients and understanding of
those who participate.