The number of uninsured hospital admissions in Hamilton County more than doubled between 2004 and 2008, leaving local hospitals with barely three in 10 patients who have private insurance to pay for their care, according to a new report on health in the Chattanooga region.
The loss of commercially insured patients, whose insurance payments are significantly higher than those of government-sponsored insurance for the same services and treatments, has contributed to hospitals' staggering losses to charity care.
In Hamilton County, hospital charity care losses totaled nearly $91 million in 2008, compared to $34 million in 2004.
More than $81 million of the losses that year were absorbed by Erlanger Health System, Chattanooga's safety net hospital.
Hospitals have felt the pain of providing more and more uncompensated care, said Craig Becker, president of the Tennessee Hospital Association.
But the pain doesn't stop there. Employers and individual consumers are feeling it in the wallet, too.
As providers are forced to cost-shift their losses from uninsured patients to commercially insured patients, private insurers have raised their monthly rates to customers, contributing to more employers and individuals being unable to afford private insurance, Becker said.
"The big problem we've seen is nobody wants to pay for health insurance," he said. "It's kind of a death spiral of, the more people dropped (from insurance), the higher the commercial rates go, the more people dropped."
Even as total hospital admissions declined by a few percentage points, uninsured admissions grew 123 percent between 2004 and 2008, driven by both cuts to TennCare and recent losses in employer-sponsored health care due to the economic recession, according to the report compiled by the Ochs Center for Metropolitan Studies and released today.
The annual Ochs report focuses on health in the six-county metro region including Hamilton, Marion and Sequatchie counties in Tennessee, and Catoosa, Dade and Walker counties in Georgia.
The 2010 report provides a sobering overview of local health statistics, from high smoking and obesity rates, to an age-adjusted death rate that exceeds the national average, and one of the state's highest infant mortality rates, in Hamilton County.
"We tend to focus on those areas where it appears Chattanooga and Hamilton County lag, because from our perspective that means there's an opportunity" for improvement, said David Eichenthal, president and CEO of the Ochs Center.
The report gives a detailed picture of the local health care system on the eve of the implementation of federal reforms, and on the heels of a severe economic downturn. A breakdown of who is paying for hospital patients' care shows patients' heavy reliance on government-funded health insurance.
Nearly two-thirds of 2008 hospital admissions were covered by government-sponsored health care: either TennCare, the state's Medicaid program; Medicare, the federal program for the elderly; or Cover Tennessee, the report said.
Across the six-county metro region, 16.3 percent of people were enrolled in the state's Medicaid program. One in four people in Sequatchie County get their health care through TennCare.
Emergency rooms locally also are experiencing a shift as the number of uninsured emergency department visits rose from 24,797 in 2004, to 40,140 in 2008, an increase of 61 percent. Visits from those with private coverage dropped from 70,534 to 67,605 in the same period.
Local emergency physician David Seaberg pointed out that total emergency room visits increased by 7.8 percent in that time period. However, the disproportionate rise in uninsured ER visitors could indicate that more uninsured people are skipping routine care and allowing illnesses to worsen into true emergencies, he said.
"You're seeing the uninsured are often probably sicker when they go in, because they don't have insurance and they do wait" to see a doctor, said Seaberg, who is dean of the University of Tennessee College of Medicine in Chattanooga.
The hospital industry supported the health care legislation passed into law in March, which is expected to bring millions of people into the private or public insurance marketplace, Becker said. But even if more people get covered, hospitals are still worried about low reimbursement rates from public programs like TennCare, which already play a major role in community hospitals' budgets, he said. Today TennCare only pays 64 percent of a hospitals' costs to provide care, he said.
"While it's coverage, it's problematic in terms of we still would have to do cost shifting," he said.
Many of the major killers in the county are related to lifestyle factors, such as smoking and maintaining an unhealthy body-mass index. Of the 3,239 Hamilton County residents who died in 2008, the leading causes of death were heart disease, cancer, chronic lower respiratory disease, stroke, Alzheimer's disease and diabetes, much like the national trends, the report said.
Obesity is a risk factor for almost all of those conditions.
In Hamilton County, half of people ages 18 to 34 were obese or overweight, compared to 74 percent of people 55 to 64. Sixty-three percent of people with a high school education or less were overweight, compared with 60 percent of college graduates. And 70 percent of people earning more than $50,000 were overweight or obese, compared to 65 percent of those earning less than $50,000.
Statistics notwithstanding, local residents have an optimistic view of their health, according to the report. Nearly two-thirds of Hamilton County residents reported that they are in excellent or very good health.
But black residents of Hamilton County were one-third less likely than whites to report being in excellent or very good health, and more than one-quarter reported they were in poor health.
Responses also varied by income level: 75 percent of people earning more than $50,000 reported they were in excellent or very good health, compared to just 53 percent of those earning under $50,000.
Racial disparities persisted in the report, as deaths from diabetes were 2.5 times higher among blacks than whites in Hamilton County, and heart disease-related deaths were 61 percent higher among blacks.
Other disparities were worrisome, and confusing, to researchers: Although cancer mortality rates were almost equivalent to the national rates, the Alzheimer's death rate in Hamilton County was almost double the national rate.
Mortality from Alzheimer's locally is also 31.4 percent higher than the statewide rate, and the reasons are unclear.
That disparity has been persistent since the Ochs Center first reported it in 2006, and warrants serious investigation, Eichenthal said.
"The reason we keep highlighting it is that it's either a really interesting reporting issue, or a really serious health issue," he said.
More elderly people moving to the area, as well as local doctors that are more attuned to a diagnosis of Alzheimer's, are the likely reason for the statistic, said Dr. John Standridge, director of the geriatric medicine fellowship at the University of Tennessee College of Medicine in Chattanooga.
"Instead of a disease cluster in the area, I think doctors are just better at listing it" on death certificates, he said. "For a while, doctors wouldn't even diagnose Alzheimer's because they thought there wasn't that much they could do about it, so they kind of brushed it under the carpet."
The health of babies born in Hamilton County is not equal across racial lines: Nearly 20 percent of babies born to black mothers weighed under 5.5 pounds, compared to about 7 percent for whites and Latinos.
Babies born underweight, typically those born premature, are at high risk for complications that can result in disabilities or death.
Single motherhood is also on the rise in Hamilton County. In 2008, 45.4 percent of Hamilton County births were to single mothers, compared with 39 percent in 2001. Nearly 82 percent of black mothers who gave birth in 2008 were unmarried.cq
On a national level, most of those single moms aren't teens, said Julie Baumgardner, of First Things First, a nonprofit focused on strengthening families in Hamilton County. Unwed mothers tend to be women between the ages of 19 and 29, she said.
(In Hamilton County, births to teens between the ages of 10 and 19 declined from 14.8 percent in 2002 to 12.5 percent in 2008, following a steady increase in the earlier part of the decade.)
Much of the increase in unwed motherhood has to do with a growing cultural acceptance of the practice, Baumgardner said.
"People are definitely choosing to live together and have children together," she said.
However, many are living in poverty without the help of the baby's father, she said. All babies born to unwed mothers face greater risk for a slew of dangers: the risk for being abused, living in poverty, becoming an abuser or ending up in jail, she said.
"It's something we all need to pay attention to. It does matter," she said.
Contact Emily Bregel at firstname.lastname@example.org or 423-757-6467.
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