Potential benefits from basic universal healthcare

A distressing problem in our nation is homelessness. It is distressing from a humane standpoint, but also due to excessive healthcare costs. As our healthcare system evolves to universal coverage, we can generate significant savings in the funds consumed by ineffective healthcare for these individuals.

 

Homeless persons habitually visit emergency departments with their health complaints. The expense of an ED visit is 15 to 30 times that of a medical office visit. Individuals leaving the ED have no effective medical follow up. Their management of chronic disease is virtually nonexistent. Their health problems are more likely to deteriorate and require hospital admissions costing tens of thousands of dollars each.

 

It is difficult to tabulate data to show how much extra expense is involved. CDC data has shown ED visits are 7.8 times as frequent with homeless persons as with the general population. A Medicaid study found that healthcare cost for persons with unstable housing was 2.5 greater. Data from Toronto showed the difference to be 5.9 times more.  

 

A recent tabulation of data in Wake County showed that while 0.1% of the population is homeless, 27% of healthcare dollars were consumed by homeless persons.

 

With a federal statute passed in 1986, hospitals across the nation are required to provide screening, clinical stabilization, and treatment or appropriate transfer of any patient presenting on their premises. Failure to do so generates financial penalties for the hospital and loss of Medicare reimbursement. This requirement is vital for humane patient care, but generates extraordinary cost for many hospitals across the country.

 

For homeless persons to be insured for basic healthcare would be a significant savings for hospitals and tax dollars. And note that hospitals charges to health insurance companies are increased to help compensate for this uninsured care. 

 

Furthermore, a huge step forward in their care would be connectivity with a primary care practitioner. A fundamental problem in our country is that less than 15% of doctors choose to practice primary care. A large majority choose an area of practice that generates more generous payment for procedures. This phenomenon increases cost for the procedures and also compromises the system of patient care overall. Optimal healthcare systems in other parts of the world have primary care practitioners comprising about half of the doctors in their country. We are using physician assistants and nurse practitioners to compensate for that deficiency. 

 

With universal basic healthcare insurance for all persons, we could realistically have each person connected with a primary care provider. Doing so is not merely a matter of individual convenience, but also a public health concern. Having a PCP would establish a doctor to access when one is sick, but also a doctor with an ongoing relationship who knows one’s history. They would provide preventive care, including vaccinations, and detect problems earlier, such as high blood pressure, diabetes and behavioral health problems. They would effectively manage chronic disease and prevent complications. The PCP would coordinate specialist referrals and help prevent duplication of tests. Such an arrangement would generate ignificant cost savings and better health outcomes. 

 

The proposed new system by providing insurance for basic healthcare and connectivity with a primary care provider for homeless individuals, would be a huge step forward in cost savings and life improvement.

 

Furthermore, major benefits would be derived by providing basic housing for these homeless persons. Data from a Pennsylvania Medicaid project showed that ED use and hospital stays declined with persons provided permanent provisional housing.

 

In our current system of healthcare, we now have greater than 35 million people with no healthcare insurance. In recent years, the portion of personal dollars needed to pay for medical care by persons with health insurance has increased significantly. Two thirds of bankrupties in this country are provoked by medical expense. Millions of people are making monthly payments on medical debt.

Our healthcare system is a major contributor to the prevalence of despair. 

 

In summary, with a system of universal basic health health coverage we could dramatically improve on costs and quality of life for homeless persons, and greatly diminish the prevalence of despair in our population. Also, we could decrease the distressing 18.4% of gross domestic product that we spend on healthcare, and so contribute to curbing our national debt. 

 

Bob Bilbro, had a career practicing internal medicine and cardiology in Raleigh, being a cofounder of Raleigh Medical Group. He has served as president of the medical staff at WakeMed and was president of the Wake County Medical Society.