No one said running a hospital in the volatile, heavily regulated U.S. healthcare market is simple, no matter how many lists emerge to ready healthcare executives for the job.
Challenges facing chief executives are significant and numerous, but the nation's growing number of uninsured ranked as the single greatest dilemma facing healthcare, according to CEOs surveyed by Deloitte & Touche for the consulting giant's 10th annual Future of Health Care Survey. Deloitte released the survey results exclusively to Modern Healthcare. The firm intends to release the report publicly this week.
Sixty-three percent of CEOs surveyed listed coverage of the uninsured as the industry's greatest need. That's compared with 22% who listed expanding information technology and 9% who cited quality as the most significant issue facing the industry.
The survey included responses from 244 executives who lead 317 hospitals, or roughly 6.5% of U.S. hospitals. Sixty-seven percent of executives work for not-for-profit health systems, 10% for investor-owned hospitals or health systems and 23% of respondents operate government-run facilities. When asked how best to expand coverage, however, the executives' consensus evaporated. Sixty percent opposed a single-payer system to expand coverage and almost as many, 58%, rejected mandates that employers provide coverage. Still, in both cases, executives clearly wanted a solution with limited government control.
That doesn't surprise Sandra Bruce, president and chief executive officer of St. Alphonsus Regional Medical Center in Boise, Idaho. "I think we're all just nervous about anybody being able to handle anything of this magnitude," she said.
She opposes a public-run, single-payer system primarily because she believes government should step in only when no other solution is available. That's not the case, she argued. Too much of healthcare financing already comes from the private sector to abandon the market entirely, said Bruce, who advocates a public-private hybrid that looks to government to help ensure basic preventive and catastrophic care for all Americans. "No American should be required to file bankruptcy because they have an acute appendix," she said.
Idaho is experimenting with premium assistance, which uses state and federal tax dollars to subsidize a share of premiums for employers with fewer than 50 workers. The state struggles with a high rate of working uninsured, she said, citing a 2001 study that found Idaho had an 18.9% rate of uninsured and, of those lacking coverage, 80% were employed.
William Schoenhard, executive vice president and chief operating officer for SSM Health Care, St. Louis, echoed Bruce's comments. "I'm not at all surprised," he said, though he also sees a limited role for government in expanding coverage. The public sector must encourage private employers and insurers to help expand access and step in as a safety-net insurer for the most vulnerable.
Census Bureau figures released Aug. 30 showed the growth in the nation's uninsured rolls slowed last year, though the percentage of Americans with public insurance, rather than employer-sponsored coverage, increased slightly (Sept. 5, p. 7).