For those who believe government never accomplishes anything of value, consider the Hill-Burton Act. In fact, if you are a healthcare executive, ponder whether you would even have your job if not for Hill-Burton, which is nearing its 60th anniversary.
In this issue, reporter Joseph Mantone takes a look at the landmark legislation, which was signed into law 59 years ago this month. Hill-Burton over six decades dramatically altered the American healthcare landscape by pumping more than $4.6 billion in grants and $1.5 billion in loans to projects that led to the construction of or equipment for about 6,800 healthcare facilities in 4,000 communities. While other programs had aided hospital building in the 1930s and 1940s, none approached the scope of Hill-Burton.
In its early years, the act emphasized rural hospital construction, so much so that most of the small, rural hospitals in this country are Hill-Burton facilities. Later, things evened out with roughly equal numbers of urban and rural facilities receiving aid.
Hill-Burton also waded into many controversies before and after it was passed. For example, it prohibited racial discrimination at facilities built with government money. It required hospitals to provide free care equaling a percentage of the federal assistance they received or a percentage of their operating costs. The law achieved limited success in these areas; the separate-but-equal doctrine and creative accounting blunted the impact of those provisions. But the act set at least minimal standards for service to the community.
The sad part of the story is that Hill-Burton was intended to go even further. A plan to provide universal healthcare coverage for Americans, as advocated by President Truman, was dropped from the bill because of cost considerations. The nation continues to suffer from this and other failures to systematically address the problem of the medically uninsured.
Nevertheless, the combined impact of Hill-Burton and Medicare3/4which just marked its 40th anniversary (July 18, p. 6)3/4on the U.S. healthcare system is staggering. The two laws poured billions in public money into healthcare concrete and compensation. American lawmakers decided to build a new healthcare infrastructure and financing system, believing that these were worthy uses of tax money. It's depressing to think that if we faced similar challenges today, we would have neither the will nor the means to take action.
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And speaking of laws and depressing thoughts, there was a story on our Aug. 8 Physician Affairs page (p. 33) that providers may want to rip out of the issue lest the magazine fall into the hands of patients. A new survey finds that many healthcare organizations are still not in compliance with the federal Health Insurance Portability and Accountability Act of 1996. More than one-quarter of the respondents reported data security breaches. Worse, the survey reports a lack of concern about the situation, with respondents saying the biggest obstacles to compliance are the lack of public relations or legal problems resulting from noncompliance.
One health system IT executive called the findings on security breaches "ugly looking stuff." Indeed, it is. The healthcare industry is fortunate that most news organizations don't cover such reports, preferring instead a steady diet of Brad and Jen or whatever the fluff du jour is. If they knew that 10 years after the passage of HIPAA, a significant number of providers would still be careless and unconcerned about security, they might demand a government crackdown with all the negative publicity that follows. Or they might insist that Congress pass new, harsher provisions for noncompliance. Then, providers would get a less pleasant example than Hill-Burton or Medicare of what government can do.