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Show 2Qlfl gQSt BI3Q Spiralling health-care costs are putting a severe strain on middle-income Americans, despite the fact that the quality of medical care is higher than it has ever been, according to Utah Foundation, Founda-tion, the private, non-profit research agency. Government-supported programs that provide care for the poor are a significant factor in rising ris-ing health care costs which are moving ahead of the general inflation, spiral. "THE WEALTHY and the poor have available the best medical care ever known, but the middle class is caught in a tight squeeze," the Foundation Founda-tion notes in a research report released this week. Top-quality medical aid for the poor is largely provided through a government-sponsored program known as Medicaid, which has become the largest single public welfare wel-fare program in the nation although it is only a little more than 10 years old. Ironically, Medicaid is a major factor in the inflation of health care costs. "IT SHOULD not be forgotten forgot-ten that every American is a potential candidate for Medicaid," said one Utah Social Services administrator. administra-tor. "At today's medical costs, even the wealthy can use up their resources in a short time under emergency conditions." Medicaid and its companion com-panion program Medicare began operation in the 1966-67 fiscal year. Since that time the rate of increase of health care costs in the United States has increased sharply (from an average annual increase of 8 percent to one of nearly 13 percent), while the outpouring outpour-ing of Federal dollars into the health-care marketplace has more than tripled in its annual an-nual rate of increase (from 8 percent a year to 26 percent a year). This has inevitably had a significant effect on health care cost inflation, although it is recognized that there are many other factors contributing contribut-ing to the price rise. MOST public criticism of government-sponsored health care programs is directed at Medicaid, which is a combined com-bined health-welfare program with split Federal-state-local responsibilities. Medicare, an insurance-type program for the elderly operated in conjunction con-junction with Social Security, appears to be operating much more effectively. While the volume of Federal spending in the medical care field about $34 billion in 1976 is of concern to American citizen-taxpayers, evidence that a sub-. stantial amount of money going go-ing into Medicaid is being wastei or stolen is even more disturbing. OFFICIAL estimates of the amount lost to fraud and abuse in the Medicaid operation opera-tion run around $900 million a year, but some Senate investigators inves-tigators estimate the total may be nearly double that amount. A national magazine recently charged that "chiselers have.. .bored into almost every phase of the program", although noting that those who criminally abuse the program represent "only a tiny portion of all participants in Medicaid." IN UTAH there are as yet no reliable figures to say whether fraud and abuse in Medicaid have reached serious proportions. Most of those working with the program, both in and out of government, feel there is nothing in Utah to compare with abuses found in the larger population centers. A new fraud and abuse-control section has recently been established es-tablished in Utah, but has not yet developed a sufficiently broad data base to make a report. In the area of Medicaid costs, Utah's experience appears ap-pears to have paralleled that of the larger states, but on a consideralby reduced scale. In the second year of the program's operation in Utah (1967-68), medical assistance payments were $9.8 million, which was less than half the amount expended for cash assistance payments. In fiscal year 1977, medical assistance had grown to $51.1 million. 28 percent more than was expended ex-pended for welfare cash assistance as-sistance payments. LARGEST single area of Utah Medicaid expenditure is nursing home care. Two recent changes in Federal regulations have sharply increased Utah's costs in this area. Reimbursement of nursing home operators has been changed from a "fixed rate" schedule, where the state and the home operators agreed on acceptable charges, to the new Federally-mandated "reasonable "reason-able cost" schedule under which operators are reimbursed re-imbursed for cost actually incurred, with liberal Federal regulations defining eligible costs. Federal regulations also al-so forced the closing of many older nursing homes and new ones have been constructed at much higher basic investment. invest-ment. "The near-universal feeling persists that some remedial action is urgently needed in Medicaid," Tjie Foundation notes. "Wh'ile virtually everyone is seriously concerned con-cerned with the high and steadily-increasing cost, every group that provides services to the program believes that it own efforts are not adequately repaid." |
