Pekin Illinois is a relatively small community located in Central Illinois half way between St. Louis and Chicago. It boasted a total community population of 33857 during the last census period of 2008. The total population consisted of roughly a 50/50 male to female ratio with a median age of 37. 1 and represented 94. 4% Caucasian, 2. 4% African American, 1. 9% Hispanic and 1. 1% Asian races.
Due to this population mix many of the culturally and racially indicated diseases states, such as type 2 diabetes, cerebrovascular and peripheral vascular diseases are not as prevalent as coronary heart disease and other related diseases such as heart failure, high blood pressure, elevated cholesterol and obesity. For this paper the focus will remain on the population of Caucasian males located in this geographic area with the generally categorized chronic disease state of heart disease.
This category will include conditions such as aneurysms, angina, arrhythmia, atherosclerosis, cardiomyopathy, congenital heart disease, congestive heart failure, coronary artery disease, dilated cardiomyopathy, diastolic dysfunction, endocarditis, hypertension, hypertrophic cardiomyopathy, mitral valve prolapsed, myocardial ischemia, myocarditis and valve disease. The reason for choosing this population in this geographic area is due to the unique, almost homogenous population.
According to internal documentation of the community hospital located in Pekin Hospital, in 2009, the hospital treated 2712 Caucasian males between the age of 45 and 84 for cardiovascular disease. This number represents 45. 6% of the target population within the primary demographic of Caucasian males, aged 45-84 in this area based upon the following formula: 11877 total aged 45-84, 501% of the total being males, 11877 x . 5 = 59369, 2712/5939 = 45. 6%.
This number is interesting when directly compared to the United States national average of cardiovascular disease being 27% of the population. Although this statistic applies to all races and both genders, it could be argued that the percentage attributed to Caucasian males is even lower due to the decreased propensity for Caucasian males to have cardiovascular diseases as opposed to African American and Hispanic males according to the American Heart Association.
Pekin has experienced levels of job loss during the current economic downturn which has resulted in unemployment rates exceeding the national levels by as much as 4%. National data on unemployment rates indicate an average of 9. 6%. Data targeted to Illinois indicate a 9. 9% unemployment rate and Tazewell county has a 9. 2% rate, however, Pekin, which is the county seat of Tazewell County has had unemployment rates ranging from 13. 8 to 11. 1 for the past 12 month cycle.
This has a profound effect on the healthcare market in this region due to individual and family health benefits being lost creating increased self-pay accounts, charity accounts, and increased number of patients seeking medical assistance through the emergency department rather than primary care facilities, patients simply foregoing medication regiments for financial reasons or simply putting off necessary medical care creating a worsening condition which will very likely create the need for more advances, and expensive care at a later date. Soon there will be another change in the cardiac disease demographic of Pekin.
As the Healthcare Reform initiatives begin to roll out, an increased number of the population will begin to receive some form of government insurance. This is estimated to be approximately an additional 781 cardiac patients. The average cost of treating a cardiac patient is in excess of &35000 (this is not the billed or reimbursed amount) however the current figures on reimbursement of government insured patients is roughly 60% of that. This incurs an automatic loss to the hospital on any patients that actually have government insurance which is estimated at 50% of the actual cardiac population.
As more under-insured patients are worked into the system, the demands for care will increase greatly however, there are no additional human resources available to adjust the new demands. The result will be increased delays across the entire patient population because of the intensive nature of caring for a cardiac patient, decreased revenues to the hospital system causing a strain on already tight operation and the very real possibility of high physician burn-out and departure due to the increased stress of having to constantly do more with less with less incentive.
In essence, the socialized medicine approach of the one-payer system will actually decrease the available care to thousands of patients because it will flood the system with under-paying, highly expectant patients that previously would not have come to the hospital for various minor health issues. This will deplete the current resources and truly afford the revenues needed to replace them. To add to the dilemma, the rising cost of healthcare will not adequately be addressed y any new healthcare system. The costs of healthcare in America are staggering and currently represent over 17% of our national GDP with the expectation of that number rising to 20% in less than 5 years. These costs are direct hits on the revenues received by hospital which affect their ability to remain operational. As the hospital’s revenues and profit margin decrease, so does the expected longevity of the hospital. Many of the costs that exceed the reimbursement are simply considered lost.
The hospital no longer has the right to bill patients for amounts exceeding the reimbursement provided by the insurance company (with some exceptions). These lost costs are simply written off the books and used as some form of tax credit. In many cases, cardiac patients without any form of insurance (8. 7% of the target population) simply can’t or won’t pay any of the costs. These are also considered lost to the system. This has the effect of increasing the loss column of the hospital’s bottom-line as well as affecting the patients’ credit and their ability to manage their own personal debt.
One possible approach to attempt to manage the continual negative downward spiral of costs versus reimbursement is to increase the general wellness of the population. The current population is easily identified since they “self” identify when they come to the hospital seeking healthcare. This population will find some, but minimal, benefit in a wellness program. The focus of such a program should be on the individuals in the two age demographics listed prior to 45 years if age, these demographics represent 30. 9% of the total population of the community and have the biggest impact on addressing the issue and derive the greatest benefit from any such program. The hospital and community have a shared responsibility to market and promote plans such as general exercise for wellness, smoking cessation classes, healthy diets, etc. The result of such activities has been proven to decrease the overall costs of future and present healthcare to both the facilities and the patients.
The cost difference between providing these programs and treating the chronic diseases caused b y neglect of the programs is staggering with estimates being millions of dollars per year saved in serviced “not” being provided. The responsibility and efforts to address the cardiac issues of the Pekin community extend beyond the hospital walls into the community leaders offices, the general business offices and every other stakeholder in this issue.
Without a concerted effort, no plan is likely to succeed however, if employers and healthcare organizations create requirement for health rather than simply suggesting it, stronger communities will emerge answering two large questions facing healthcare: how are we going to service the increased needs of the future and who is going to pay for it.
References Intervening on the Social Determinants of Cardiovascular Disease and Diabetes Leandris C. Liburd, MPH, MA, Leonard Jack, Jr. , PhD, MS, Sheree Williams, PhD, MS, Pattie Tucker, DrPH, MPH, RN ttps://www. cuny. edu/about/centers-and-institutes/urban-health/campaign-against-diabetes/policyreports/leandris_liburd3. pdf http://www. wehealny. org/services/cardiology/symptoms2. html http://www. americanheart. org/presenter. jhtml? identifier=4478 http://lmi. ides. state. il. us/download/LAUS_CURRENT_CITY. pdf http://pekin. areaconnect. com/statistics. htm http://www. ci. pekin. il. us/files/document/pdf/3-2010%20demographinc%20profile. pdf http://lmi. ides. state. il. us/download/LAUS_CURRENT_COUNTY. pdf