Wednesday, December 30, 2009
Keeping an Eye on Care in Richmond
Leonhardt writes:
"Since 1996, the Richmond area has lost more than 600 of its hospital beds, mostly because of state regulations on capacity. Several hospitals have closed, and others have shrunk. In 1996, the region had 4.8 hospital beds for every 1,000 residents. Today, it has about three. Hospital care has been, in a word, rationed."Leonhardt also looks at the certificate of need process that hospitals and care facilities need to undergo in order to expand services, move locations, or significantly upgrade their technology. Basically facilities have to justify their intentions by applying for a certificate. If it's deemed warranted, they get the go ahead, if not, they are out of luck. On that Leonhardt notes, "[i]t is one of 37 states with a certificate of need program, and unlike some, Virginia’s is more than a mere formality."
While I believe the supply shrinkage could and probably does have a positive effect at lowering the cost of care in Richmond, I don't think Leonhardt makes a necessarily persuasive case. For example, cost drivers in care aren't just the amount of supply that an area has, it's also the population they are serving. How sick are they? How are they consuming health care resources?
The populations that are the sickest or are the biggest consumers of care tend to be those that are uninsured, lack access to primary care, or are older. However Leonhardt didn't get into any specifics here, and that's too bad.
As a legislative fellow working with the Health, Welfare and Institutions Committee last spring, I was able to witness the certificate-of-need process up close and personal: It works. Communities, advocates, and other stakeholders are able to participate in the conversation of what their health care needs and wants are.
But what makes it effective in Virginia may not translate into similar success in other localities. I'm hastened to say that if 36 other states have a such a process, then the sheer number of states involved tell you that certificate of need process alone is not working. The consumption of health care continues to increase.
I hope Leonhardt looks at Virginia in comparison to another one of those states that also use the certificate of need process. Maybe an extra variable or two can be isolated and we'll be able to break new ground.
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