The fall of the house of AHERF: the Allegheny bankruptcy.
(1/20)
The $1.3 billion bankruptcy of the Allegheny Health, Education, and Research Foundation (AHERF) in July 1998 was the nation's largest nonprofit health care failure. Many actors and factors were responsible for AHERF's demise. The system embarked on an ambitious strategy of horizontal and vertical integration just as reimbursement from major payers dramatically contracted, leaving AHERF overly exposed. Hospital and physician acquisitions increased the system's debt and competed for capital, which sapped the stronger institutions and led to massive internal cash transfers. Management failed to exercise due diligence in many of these acquisitions. Several external oversight mechanisms, ranging from AHERF's board to its accountants and auditors to the bond market, also failed to protect these community assets. (+info)
TennCare--Medicaid managed care in Tennessee in jeopardy.
(2/20)
TennCare, the statewide Medicaid managed care system implemented in Tennessee on January 1, 1994, sought to reduce state and federal healthcare expenditures while enhancing access to and quality of care. TennCare currently covers 1.32 million enrollees (25% of the citizens of Tennessee), including more than 520,248 citizens previously not covered by health insurance. It is one of the largest Medicaid managed care enterprises in the nation and the only program to cover uninsurables regardless of income. Utilization of preventive and primary care services has increased, and selected measures of quality of care have improved. Program costs from 1994 through 1998 rose at a rate below that of overall US Medicaid costs during the same period, resulting in modest savings. However, managed care plans, hospitals, and individual providers continue to report substantial fiscal losses, and managed care organizations--including the 3 largest plans in the program--have closed, been placed under receivership, or threatened to withdraw from the market. Furthermore, safety net hospitals, academic medical centers, and community mental health programs have fared financial cutbacks that have limited their ability to serve the remaining uninsured as well as the insured. Because of these fiscal difficulties, the TennCare program is now in significant jeopardy despite its important clinical successes. Major structural and fiscal changes will be required if the program is to continue to enhance services and remain financially viable. This report focuses on TennCare's successes and failures to offer lessons for Medicaid managed care programs nationwide. (+info)
Out of the frying pan: New York City hospitals in an age of deregulation.
(3/20)
For several decades New York City hospitals had been distinguished by their tightly regulated environment, chronically weak finances, high occupancy rates, teaching intensity, dependency on public payers, low managed care penetration, and minimal merger activity. Then in the late 1990s a rapid convergence of forces--the Balanced Budget Act, managed care growth, state deregulation of commercial rates, escalating costs, and plunging hospital occupancy rates--threw the city's hospital industry into turmoil. In this paper we describe this period of turbulent change that has left most of the city's safety-net and small community hospitals near bankruptcy. (+info)
The financial performance of community health centers, 1996-1999.
(4/20)
This paper presents recent financial health trends of community health centers (CHCs) between 1996 and 1999, a time characterized by fiscal and operating challenges. Results show that many individual CHCs have been subject to large changes in payer-mix among uninsured and Medicaid users. Troubling is the finding that more than half of all CHCs reported operating deficits in 1997, 1998 and 1999. CHCs experiencing large increases in the share of uninsured users and those participating in Medicaid managed care appear to have been disproportionately affected. The analyses presented support recommendations for enhanced data collection and for further monitoring of CHCs' financial health. (+info)
Reasons for student debt during medical education: a Michigan study.
(5/20)
The authors address the need for a better understanding of the reasons for greater indebtedness among today's osteopathic medical students. In May 2000, a survey was mailed to all 219 osteopathic interns at participating institutions in Michigan. The self-administered survey contained 19 questions designed to gather basic financial information, demographic characteristics, and subjective perceptions of student debt loads from participating interns. One hundred seventy completed surveys were returned, for a response rate of 78%. The authors attempted to focus on demographic predictors of debt and found that although there is no indication that such predictors have a significant effect on a student's total debt load, financial support from the student's family remains the single most important factor in predicting low levels of student debt. The authors suggest that the higher debt rate of students entering specialty fields may reflect the fact that students incur these debts with the knowledge that those debts will be more easily repaid once the student has begun to practice medicine. (+info)
Illness and injury as contributors to bankruptcy.
(6/20)
In 2001, 1.458 million American families filed for bankruptcy. To investigate medical contributors to bankruptcy, we surveyed 1,771 personal bankruptcy filers in five federal courts and subsequently completed in-depth interviews with 931 of them. About half cited medical causes, which indicates that 1.9-2.2 million Americans (filers plus dependents) experienced medical bankruptcy. Among those whose illnesses led to bankruptcy, out-of-pocket costs averaged dollar 11,854 since the start of illness; 75.7 percent had insurance at the onset of illness. Medical debtors were 42 percent more likely than other debtors to experience lapses in coverage. Even middle-class insured families often fall prey to financial catastrophe when sick. (+info)
Medical bankruptcy: myth versus fact.
(7/20)
David Himmelstein and colleagues recently contended that medical problems contribute to 54.5 percent of personal bankruptcies and threaten the solvency of solidly middle-class Americans. They propose comprehensive national health insurance as a solution. A reexamination of their data suggests that medical bills are a contributing factor in just 17 percent of personal bankruptcies and that those affected tend to have incomes closer to poverty level than to middle class. Moreover, for national health insurance to have an impact, it would have to define "medical" expenses in a much broader way than is now typical of either private or government-funded plans. (+info)
Discounting the debtors will not make medical bankruptcy disappear.
(8/20)
David Dranove and Michael Millenson seem determined to deny that financial fallout from illness pushes middle-class families into bankruptcy. Anxious to erase the headline that three-quarters of U.S. medical bankrupts had health insurance at the onset of their illnesses and the resulting spotlight on inadequate coverage and insurance cancellation practices, they ignore most of our data and misrepresent the rest. They dismiss families' explanations of their difficulties and blame those ruined by illness for their own problems. However, the data from the bankruptcy courts are undeniable. Bankruptcies affect mainly middle-class, privately insured families, and about half are triggered, at least in part, by illnesses. (+info)