Cost Of Care

For the 700,000 Marylanders who lack health insurance, somebody else ends up footing the bill. Last year, hospitals were left with $400 million in uncompensated care.A large share of that bill falls on inner-city hospitals in Baltimore City where many uninsured patients live. Then a vicious cycle begins, in which these city hospitals have to raise their rates to counteract their financial losses on charity care, while hospitals elsewhere are able to keep charges comparatively low and draw more patients whose insurance can pay the bills.

E veryone makes mistakes. Despite their best efforts, doctors, hospitals and other health care providers make their share. So do government bureaucrats. But there's a big difference between an error and a deliberate act of fraud. Those who knowingly and deceptively create a false medical claim in order to bilk the government out of large sums of money deserve no sympathy whatsoever. That's why one of the bigger errors made by members of the Maryland General Assembly last year was to reject a bill that would have helped the state crack down on Medicaid fraud.

Members of the Maryland Association of Certified Public Accountants are answering readers' tax questions through April 15. See below for how tosubmit a question. Is a child care tax deduction available for toddlers enrolled in pre-K3, pre-K4 and kindergarten if you have to pay to send them to classes? Yes. But the IRS makes a distinction between the cost of "care" and the cost of "schooling." Normally, only the cost of care can count toward the credit. But if your child is in a grae below first grade, and the amount you pay for "schooling" is incidental to and cannot be separated from the cost of "care," you can count the total cost of sending you child to preschool.

For centuries, doctors were in charge of health care decisions for their patients. During the last couple of decades, doctors have been driven out of the decision-making process. Health care decisions are made by administrators (substitute "bureaucrats" in the future) employed by insurance companies to keep costs down. To make matters even worse, doctors live in fear of lawsuits and ever-increasing malpractice premiums and sometimes order unnecessary tests and procedures just to cover their rear ends.

The state agency that regulates hospitals will allow Blue Cross and Blue Shield of Maryland to keep a discount worth nearly $20 million pending a public hearing in September.The Maryland Health Services Cost Review Commission yesterday agreed to take a second look at the 4 percent discount on hospital costs granted insurers that provide coverage to all comers during open enrollment periods.The hearing will determine whether the benefits provided to people turned away by other companies because of their medical conditions justify the millions of dollars in discounts to the Blues and a few other companies known as insurers of last resort.

For centuries, doctors were in charge of health care decisions for their patients. During the last couple of decades, doctors have been driven out of the decision-making process. Health care decisions are made by administrators (substitute "bureaucrats" in the future) employed by insurance companies to keep costs down. To make matters even worse, doctors live in fear of lawsuits and ever-increasing malpractice premiums and sometimes order unnecessary tests and procedures just to cover their rear ends.

THE CHILD-CARE dilemma is often written off as a problem for working parents, which lets everyone else off the hook. But as any first-grade teacher can testify, the quality of care in the pre-school years makes a huge difference in a child's prospects for success in school. For that reason alone, the issue is worth the attention of the presidential bully pulpit.But as important as it was that President and Mrs. Clinton convened a White House conference on child care last week, we'll know we are really making progress when school superintendents or even university presidents convene such gatherings to highlight the fact that these early years are crucial learning years -- and that the academic training of child care workers is as important as the training of any other teacher.

For all the work Christopher Reed has done as vice president of fundamental research for Harris Investment Management Inc. in Chicago, he still can't figure out whether he should buy long-term-care insurance for his parents. "There are so many variables in long-term care and so many issues - health, taxes, estate planning," he said. "Then you get presented with a policy and your eyes glaze over." Long-term-care policies are designed to help pay for all sorts of expenses people can incur as they age. These range from such simple things as home help in performing everyday tasks that are taken for granted, such as bathing and eating, to the cost of a nursing home, hospice or assisted-living facility.

In a sign of the difficulties besetting groups of doctors aligned to secure managed care contracts, one area entity has thrown in the towel while another has retrenched after losing business.New American Health, the managed care contracting arm of the North Arundel Health System, is closing, with the loss of about 40 jobs. Doctors Health, of Owings Mills, laid off 52 of its 148 headquarters staff members this week after losing a major contract.Doctors Health is the largest of the so-called equity model physician groups in the area.

READING the recent Gallup report on health-care costs was a little like hearing Martin Luther King Jr. give a speech on civil rights. We already knew the message, but we needed something more to inspire us to action.Gallup found that 91 percent of the chief executive officers of the nation's largest companies believe a fundamental change or complete rebuilding of the health-care system is needed. That is no surprise; the cost of medical care in the United States is 40 percent more per capita than anywhere else in the world, and as much astwice the cost of care in many industrial nations.

We've been hearing a lot about universal health care. But before you give up on market competition, consider that government regulation of hospitals and medical professionals makes medical care much more expensive than it need be. We seldom hear about difficulties in finding a doctor, rationing of services and poor-quality care under universal health care schemes - even though such problems are already happening in government-run programs in California....

In an ominous sign for drug makers, the number of prescriptions dispensed by pharmacies in the United States is growing at its lowest rate in at least a decade as consumers are squeezed by both a troubled economy and the growing burden of out-of-pocket health-care costs. The pharmaceutical industry by conventional wisdom is resistant to economic downturns, because people need medicine in good times and bad. But data from market researcher IMS Health and Wall Street analysts indicate that the rate of prescription growth has fallen steadily since early last year and in recent months has slipped in and out of negative territory.

It's not a sexy issue such as gay marriage or illegal immigration, yet the importance of what we do - or don't do - regarding the health and housing needs of our seniors may have more economic, physical and moral relevance for families than any other problem before us. Let's face it, Americans simply don't plan for old age - either individually or as a society. We focus on youth; envy and sex lurk behind our every advertised need. The media, with their focus on the scandalous and the sweet, don't help much.

MinuteClinic is closing its six locations at Target outlets in the Baltimore area next month, but opening seven in nearby CVS drugstores. The shift doesn't represent a retreat for the concept of basic-care clinics in retail stores. In fact, it signals the opposite - a jockeying for position as quick clinics enter a period of rapid expansion and increased competition. "As we looked at the future, we believe strategically we will be able to grow quicker through CVS," said Michael Howe, MinuteClinic's chief executive.

WASHINGTON - Sandy Matteson was heartsick as she watched her parents' life savings being eaten up in $6,000-a-month bites to pay for their nursing home care. Then she spotted an ad promising what she thought was impossible: protecting her parents' savings by getting the taxpayers to foot the bill. By legally finessing complex government regulations, Matteson got Medicaid, the health insurance program for the poor and disabled, to pay half of the nursing home bill, saving her family $37,500 a year.

For all the work Christopher Reed has done as vice president of fundamental research for Harris Investment Management Inc. in Chicago, he still can't figure out whether he should buy long-term-care insurance for his parents. "There are so many variables in long-term care and so many issues - health, taxes, estate planning," he said. "Then you get presented with a policy and your eyes glaze over." Long-term-care policies are designed to help pay for all sorts of expenses people can incur as they age. These range from such simple things as home help in performing everyday tasks that are taken for granted, such as bathing and eating, to the cost of a nursing home, hospice or assisted-living facility.

With momentum for health reform building, Maryland hospitals are squaring off against managed-care companies in a struggle that will determine how health care is delivered in the state.The looming battle is an outgrowth of marketplace pressures that began mounting as a result of spiraling health care costs and anticipation of the Clinton administration's health care reform plan, unveiled last month.Arrayed on one side are those favoring an incremental evolution of the hospital regulatory system.

In an ominous sign for drug makers, the number of prescriptions dispensed by pharmacies in the United States is growing at its lowest rate in at least a decade as consumers are squeezed by both a troubled economy and the growing burden of out-of-pocket health-care costs. The pharmaceutical industry by conventional wisdom is resistant to economic downturns, because people need medicine in good times and bad. But data from market researcher IMS Health and Wall Street analysts indicate that the rate of prescription growth has fallen steadily since early last year and in recent months has slipped in and out of negative territory.

Tens of thousands of retired workers, long accustomed to generous health benefits, are being hit by huge increases in premiums as rising medical care costs strain tight corporate budgets in a lackluster economy. The costs for providing benefits to retirees are rising even faster than premiums for active workers, pushing more companies to eliminate future retirement health benefits. More than 12 million retirees have some kind of medical coverage, provided by about half of U.S. companies with 1,000 or more employees.

A would-be model program, planned for more than a year to help incarcerated women keep and bond with their newborn babies, has been scuttled because corrections officials say they can't cover its medical costs. The $3.5 million program, called Tamar's Children, was to be one of the first in the country to keep female inmates with their babies in a special facility after they give birth. There, they would have received treatment and counseling for trauma, drug abuse and other ills that lead many women to prison, said Andrea Karfgin, a clinical psychologist who directs the project.