Chapter 12 explores the important issues of cost, access and quality, including that having access to affordable quality health services is both (1) a key determinant of health care a

Chapter 12 explores the important issues of cost, access and quality, including that having access to affordable quality health services is both (1) a key determinant of health care and (2) a significant benchmark in assessing the effectiveness of the health care delivery system. 

In chapters previously discussed in this class, we have studied that vulnerable populations experience great challenges in:

• Accessing health services, 
• Paying for health services (which contribute to the access problem), and 
• Receiving quality health services (as opposed to the quality typically available to non-vulnerable populations).   

Vulnerable population groups include racial/ethnic minorities, the uninsured, children, women, persons living in rural areas, migrant workers, homeless persons, persons with mental illness, the chronically ill, and persons with a disability.  While members of the population groups listed above often have incomes at or below the federal poverty level, I think that poverty could perhaps be added as a distinct vulnerable population group.  With the exception of the population groups for women and children, any of these vulnerable population groups include adult men.  Therefore, the vulnerable population groups include people from every population group.  

Those living in rural areas are especially hard-hit with finding access to medically necessary health services.  Challenges that they face include, at the most basic level, poverty and the chronic health conditions associated with poverty.   Other challenges of living in a rural area include a shortage of health care providers, a lesser quality of care, a lack of health insurance, and increasingly, the loss of a community hospital that includes in its mission an obligation to serve the health needs of special populations.

Assume that you are the CEO of a rural hospital in an agricultural community characterized by high poverty, high unemployment, and poor health status due to chronic health conditions.  You are fortunate that your hospital was just purchased by a larger health system and you now have access to financial resources that will enable your hospital to invest in its future for the first time in 25 years.  You are excited about bringing new programs to improve access for the community's long neglected vulnerable populations.  

However, you have a newly constituted board of directors that has as its focus achieving financial stability followed by growth.  The board views the community's high percentage of residents who fall into the vulnerable population as a reason for the hospital's financial struggles, and has directed you to improve the payer mix by replacing the uninsured and Medicaid patients with commercially insured and private pay patients.  The board has also directed you to:

• Recruit young doctors trained in state-of-the-art medicine and technologies;  
• Implement  cash cow programs such as orthopedic surgery, cosmetic surgery, pain management, oncology, post-acute rehabilitation, etc.; 
• Reduce the hospital's charity and bad debt accounts; 
• Invest in an electronic medical record platform; and 
• Make needed facility improvements and medical equipment purchases.    

How will you, as hospital CEO, utilize the recent infusion of capital from the new health system owner to achieve the board's financial objectives while also improving access to necessary health services by the vulnerable populations served by your hospital (mostly uninsured and Medicaid)?  Is your goal of improving access to the community's vulnerable populations fundamentally inconsistent with the board's goal of increasing revenues and modernizing the hospital; or can the two goals be reconciled and mutually achievable?  If your goal is inconsistent, how is it inconsistent?