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Interviews
Joe Krella
President & CEO
Utah Hospital Association
Interviewer
Are we in a crisis with healthcare?
Joe Krella
I think it's reaching the point where we are getting to a crisis in healthcare, with the primary reason for that being the number of uninsured in the nation and the lack of access to affordable healthcare insurance.
Interviewer
Is it primarily a financial issue?
Joe Krella
I think cost is definitely becoming a big issue, particularly nationally, but here in Utah we're very fortunate in that we have very cost effective providers. The cost of healthcare in Utah is probably the lowest in uh the nation.
Interviewer
Why are costs so high?
Joe Krella
Well in terms of cost and what's driving it on the hospital side, particularly technology, labor shortages, increasing salaries, also individuals who access the healthcare system probably inappropriately. And that would be particularly through the emergency department where individuals, particularly those who lack healthcare insurance, use the emergency room for their primary care.
Interviewer
How do the uninsured play into the equation?
Joe Krella
It's a huge issue. If you look nationally we have roughly 46 million uninsured individuals in this country. There's another 300,000, roughly 12% of the population in Utah that are uninsured. So we have to find a way to get affordable coverage to those individuals who currently don't have it.
Also, a huge chunk of the uninsured are individuals between the ages of 19 and 25, young males. People who often think that they are the young immortals, that they don't need to have health insurance because they're young, they're fit, and they're not going to become sick, but that absolutely is not true.
Everyone who doesn't have insurance and employers who don't provide insurance are all contributing to the problem. If we look at what a potential solution is, I don't think at this point it's going to happen nationally, I think the states are going to be relied upon to come up with their own solutions to covering all those who don't have insurance. One of the principles we need to adhere to in that regard is shared responsibility. As much as we're all paying for the care for those who can't afford it, or who don't have insurance, we all have a shared responsibility that being individuals, employers, government, insurers, in participating in a plan to cover everyone in this state.
Interviewer
Are Emergency Departments becoming the de facto health care provider for many uninsured?
Joe Krella
Well, we would never discourage anyone who feels that they have an emergency from going to an emergency department. But it's one of the most expensive venues in terms of receiving care and then if you look at an issue that is identified in terms of healthcare for an individual, there's really no continuity or follow up with additional primary or specialty care. So it is a very inefficient, very expensive way to access the healthcare system.
Interviewer
How is this contributing to rising costs?
Joe Krella
If you look at the hospitals in Utah, we provide almost 300 million dollars a year in uncompensated care. Most of that being charity. So that means individuals who don't have insurance or don't have the ability to pay. That puts a tremendous financial strain on the systems, when we just talked about the issues of cost. Hospitals can't afford to keep spending that amount of money caring for those individuals when we need to invest in new technology, when we need to invest in new facilities, and we need to invest in adequate staffing.
Interviewer
But those costs must get passed on in some way. Who is ultimately paying for charity care, and the cost of the uninsured?
Joe Krella
We're all paying it. If you look at employers who provide health insurance for their employees, they are essentially paying 17% hidden premium tax to cover those individuals who are also employed, but don't get coverage through their employers.
Everybody pays, there's no free ride.
Interviewer
We’ve interviewed people who can’t afford to treat their diabetes, or other chronic illnesses, and then they face a medical crisis. Do Utah Hospitals often see people showing up in the Emergency Room with a condition that could have been prevented?
Joe Krella
Sure, it's a huge issue, and it's a big issue particularly for those low income individuals who are struggling to raise families and are debating whether they should buy health insurance, should I use my money to put food on the table, to buy clothes for the kids. So typically you find that those individuals do delay receiving care even if they are symptomatic in some fashion. And then when they do access the healthcare system, again, predominantly through the emergency department, their condition has increased to the point where it potentially is chronic and life threatening and again, very expensive to treat.
Interviewer
We’re also looking at cultural barriers in the documentary. Over the last decade there has been a rise in the immigrant population of Utah -- both documented and undocumented. How is this effecting hospitals?
Joe Krella
The illegal immigrant population is becoming a very significant problem for hospitals across the country and particularly here in Utah as well. Uh again, federal law stipulates that if you present an emergency the hospital has to treat you, they have to triage you, and that applies to illegal immigrants as well. And certainly hospitals in this state aren't going to turn anyone away. But that also leads to overcrowding and delays to individuals who need access to getting that care.
Interviewer
Are hospitals part of the Safety Net?
Joe Krella
Hospitals are part of the safety net. We have an excellent safety net system in this state, with community health centers, government operated free clinics for those who don't have the financial means to pay for care, but people rely on our emergency clinics as part of that safety net as well. Again, we are there 24 hours a day 7 days a week, and we'll provide care to anyone who shows up at the door.
I think we can be looked at as the ultimate safety net. As good a job as community health centers and others do, they aren't open 24 hours a day. We are. They aren't open 7 days a week, we are. So again, anyone looking for care and who may fall through the cracks uh relies on the emergency department to get their care.
Joe Krella
Well we not only have such a rural population, but we have a frontier population as well, and those hospitals and those individuals face very unique challenges. Again, access to care, or individuals not having access to care is really a misnomer. Folks do have access even if they don't have insurance. The problem is they have access to the system in the most expensive and probably inefficient way, and then don't have opportunity for follow up or continuity of care. If you look at the rural areas, their challenge primarily lies in the area of recruitment. It's very difficult to recruit physicians who want to practice in those areas. But again, the hospitals are there 24 hours a day seven days a week to treat those individuals.
