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Show cdicaid costs concern Utah and i lie nation Spiralling health - care costs are putting a severe strain on middle-income A -mericans, despite the fact that the quality of medical care is higher than it has ever been, according toUtah Foundation, the private, non -profit research agency. Government -supported programs pro-grams that provide care for the poor are a significant factor in rising health care costs which are moving a-head a-head of the general inflation spiral. "The wealthy and the poor have available the best medical med-ical care ever known, but the middle class is caught in a tight squeeze," the Foundation Founda-tion notes in a research report re-port released this week. Top -quality medical aid for the poor is largely provided pro-vided through a government-sponsored government-sponsored program known as Medicaid, which has become the largest single public wel -fare program in the nation although it is only a little more than 10 years old. Ironically, Medicaid is a maior factor In tho inflaHnn operation in the 1966-67 fiscal fis-cal year. Since that time the rate of increase of health care costs in the United States has increased sharply (from an average annual increase in-crease of 8 to one of nearly 13), while the outpouring of Federal dollars into the health -care marketplace has more than tripled in its annual an-nual rate of increase (from 8 a year to 26 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 con-tributing to the problem. Most public criticism of govern ment - sponsored health care programs is directed di-rected at Medicaid, which is a combined health -welfare program with split Federal state -local responsibilities. Medicare, an insurance -type program for the elderly operated op-erated in conjunction with Social Security, appears to be operating much more effectively. ef-fectively. While the volume of Federal Fed-eral SDendine in the medical of health care costs. "It should not be forgotten that every American is a potential candidate for Medicaid," Med-icaid," said one Utah Social Services administrator. "At today's medical costs, even the wealthy can use up their resources In a short time under emergency conditions." condi-tions." Medicaid and its companion compan-ion program Medicare began care field about$34 billion in 1976 is of concern to American citizen -taxpayers, evidence that a substantial substan-tial amount of money going into Medicaid is being wasted or stolen is even more disturbing. dis-turbing. Official estimates of the amount lost to fraud and abuse In the Medicaid operation run around $900 m illion a year, but som e Sen -ate investigators estimate the total may be nearly double that amount. A national na-tional magazine recently charged that "chislers have bored into almost every phase of the program", although al-though noting that those who criminally abuse the program pro-gram 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 ser-ious proportions. Most of those working with the program, pro-gram, 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 in Utah, but has not yet developed a sufficiently suf-ficiently 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 c onsiderably 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 ex-pended for cash assistance payments. In fiscal year 1977, medical assistance had grown to $51.1 million, 28 more than was expended for welfare cash assistance payments. pay-ments. Largest single area of Utah Medicaid expenditure is nursing home care. Two recent changes in Federal regulations have sharply increased in-creased 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, char-ges, to the new Federally-mandated Federally-mandated "reasonable cost" schedule under which operators opera-tors are reimbursed for costs actually incurred, with liberal Federal regulations defining eligible costs. Federal Fed-eral regulations also forced the closing of many older nursing homes and new ones have been constructed at much higher basic investment. "The near -universal feeling feel-ing persists that some remedial re-medial action is urgently needed in Medicaid," the Foundation notes. "While virtually everyone is seriously ser-iously concerned with the high and steadily -increasing cost, every group that provides pro-vides services to the program pro-gram believes that its own efforts are not adequately repaid." |