Cost-effective care is big underlying issue

There are two strategies that states can use to address the problem of low-income adults who can't afford health care, according to Jonathan Seib, a policy advisor to Washington Gov. Chris Gregoire in Olympia.

Some have reduced the portion of charges for which the patient is responsible, either indirectly through subsidized insurance coverage or directly through hospital charity care policies and grants to community clinics. The second approach, though, is more long-term: Doing something to control the rising costs of care.

Gov. Gregoire has made it clear that this underlying problem is not to be overlooked, says Mr. Seib. "It's important to her that our efforts address the cost of care, as opposed to just making sure that people can afford care at whatever cost it might be," he says, adding that taking better advantage of electronic information systems is one possible approach. This will allow public programs to stretch further and reduce the burden on those who still do not qualify for such assistance.

"In the health care reform discussions in Washington, she has been very clear that for every dollar we spend, we get the most for that dollar," says Mr. Seib. "We are not spending money where it does no good."

The overall amount people pay for care depends on two things: how frequently services are received and how much they cost. "We have the tools to help control unnecessary expenses with regard to both of these," he says. "It shouldn't be lost in the discussion. In fact, it's very important to our Medicaid program that we continue our efforts to improve the quality and cost-effectiveness of care, so what money we use is used wisely and provides needed care to as many people as possible."

No single solution

"While one has to be careful about claims that we can reduce the cost of care, there is certainly promise to containing the cost or moderating the rate of increase," says Mr. Seib.

He says the one key is to use information technology to get better information to purchasers, providers, and patients, so the right decisions can be made more frequently. For example, consumers need to be provided with information so they can make better choices about how their health care dollars are spent.

"There is no single solution. There is an array of solutions to make sure we get the most health care for the least cost, that whatever dollars are available are well spent," says Mr. Seib.

He gives the example of Washington state's pilot program for health literacy, which educates parents of primarily low-income children to better address their children's health care needs. For instance, the parents are told at what point they need to go to the ED for an asthma attack, and when they can wait until the following day to see a primary care physician.

"The results have been impressive and encouraging," says Mr. Seib. "They have learned to use the health care system better. Not only is the care their child receives more appropriate, but it costs the system less, too."

In any given year, the dollars available to fund state programs will vary. "But regardless of the dollars available, we want to make sure that we get the most health care for the most people that we can," he says. "These strategies are particularly important in difficult budget times when it is much harder to simply increase funding for state subsidized programs."

The idea is simple: If less can be spent on every person that is covered because they get care in a more appropriate way, then there will be money available to cover more people. "When you don't pay for unneeded care, you have more funds to pay for needed care," says Mr. Seib. "This is true whether it's the state, a business, or an individual paying the bill."