West Michigan 
Health Scorecard

Spring 2005
Volume I, No. 4  

Quality of Health Care

þ  Preventable hospitalizations accounted for 11.5% of the total number of discharges from Michigan hospitals for those 19 years of age and under in 2002, 9.1% in West Michigan. Preventable Hospitalizations are hospitalizations for conditions where timely and effective ambulatory care can decrease hospitalizations by preventing the onset of an illness or condition, controlling an acute episode of an illness or managing a chronic disease or condition.

þ       The leading cause of preventable hospitalizations in Michigan in 2002 for children was asthma, accounting for 21% of preventable hospitalizations.  West Michigan children fare somewhat better at 14.2%.  

Data Source – Michigan Inpatient Data Base (MIDB) & Michigan Department of Community Health (MDCH), Division for Vital Records and Health Statistics. MIDB uses age 19 & under for children, while MDCH uses age 18 and under.

Cost of Health Care

þ     The average cost of a hospital stay in West Michigan is $6,000, or about $1,796 per day based on an average length of stay of 3.34 days. Data Source – Milliman and Robertson and Michigan Inpatient Data Base. 

þ       In West Michigan in 2002, children accounted for 102,402 days of hospitalization.

þ   Approximately 14,541 hospital days were used by asthma patients, at the average cost of $1,796 per day for a total cost of approximately $26,115,636.

Data Source – Michigan Inpatient Data Base & Michigan Department of Community Health, Division for Vital Records and Health Statistics.

Health Status

þ       In the United States, an estimated 6.1 million children  have asthma, or approximately 140 per 1,000 population

þ       4,269 deaths were caused by asthma in 2001.  The age-adjusted death rate is 1.5 per 100,000.

þ       Asthma caused 14.6 million lost school days in 2002, and is the leading cause of school absenteeism. 
Data Source – American Lung Association

Access to Health Care

þ  19 of 79 (24%) West Michigan primary care pediatricians accept children covered by Medicaid.

þ   16 of 79 (20%) West Michigan pediatricians have Spanish language capabilities.

þ         14 of 79 (18%) West Michigan pediatricians accept children with Medicaid AND have Spanish language capabilities.
Data Source – Telephone survey of pediatrician practices representing 79 total physicians - conducted by The LaPenna Group during October 2004. Family physicians and pediatric subspecialists were not surveyed.

Feature Article - “Children at Risk”

The American Academy of Pediatrics says that the medical care of children should be accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective. It should be delivered or directed by well-trained physicians who provide primary care and help to manage and facilitate essentially all aspects of pediatric care. The physician should be known to the child and family and should be able to develop a partnership of mutual responsibility and trust with them. These characteristics define a "medical home."

The need for an ongoing source of health care—ideally a medical home—for all children has been identified as a priority at the national level. The US Department of Health and Human Services’ Healthy People 2010 goals and objectives state "all children with special health care needs will receive regular ongoing comprehensive care within a “medical home," and multiple federal programs require that all children have access to an ongoing source of health care. 

What if you are a child who qualifies for Medicaid?  

One in four American children (24 million) are covered by Medicaid, the nation’s single largest payer of children’s health services. There are 1.3 million Medicaid recipients in Michigan, of which about 26%, or nearly 350,000, are children. This is over a fourth of all children in Michigan. 

The lack of access to pediatric health care providers for children covered by Medicaid is a problem nationwide and right here in West Michigan. According to a survey conducted of pediatric practices in West Michigan, only 24% of West Michigan primary care pediatricians accept children with Medicaid. (Family physicians and pediatric subspecialists were not surveyed).

What is the impact of lack of access for children insured by Medicaid? 

Having Medicaid coverage does not insure that you have a medical home. Hundreds of children do not have a medical home. Their families turn to the local emergency departments, walk-in clinics, and other urgent-care facilities for minor illnesses and severe conditions alike. In contrast to care provided in a medical home, care provided through these outlets, though sometimes necessary, is more costly and often less effective. In addition, higher health care costs develop because those families without access to primary health care coverage often delay receiving care until they are very ill.

Which factors contribute to the lack of access for children insured by Medicaid?  

Inadequate payment for services offered in the medical home is a very significant barrier. On average, providers who care for pediatric patients covered by Medicaid receive approximately 50% of the reimbursement they receive for providing the same service to Medicare patients. The stigma of Medicaid no doubt plays a role as well. Many children are without care due to barriers resulting from language, race and socio-economic factors. 

Pediatrics is a specialty that is at the bottom of the reimbursement scale.  Low provider reimbursement under Medicaid is also a significant driver of the current shortage of pediatric subspecialists, which affects all children – not just those covered by Medicaid. Some doctors do not choose pediatrics training because it cannot support them the way other specialty endeavors can. Some family medicine physicians limit their practices only to adults, even through they effectively can treat pediatric problems. Physicians are not substandard because they accept Medicaid patients. 

Where are the savings from underfunding the Medicaid program? 

It is a myth that underfunding saves taxpayer dollars. The fact is that underfunding providers leads to shifting costs to private payers, employers and employees who end up subsidizing care through higher insurance premiums. 

What can be done?  

The system as it is now does not work for many. Children can be victims of a misplaced set of priorities and goals. There is a high value in prevention of childhood risk and diseases, but this requires some form of social re-engineering.  

This could be addressed through programs similar to the campaign launched in the 1950’s to successfully eradicate polio. This was a combined public health program that was school-based. Many adults remember getting the vaccine in the first and second grade, and there is no better way to address the present crisis. Presently, educators have been enlisted in the fight to stem child abuse and we must recognize that diet and nutrition and access to vaccinations and other screenings are important, as well.  

While schools represent an obvious channel to reach our children, there are other avenues that might be considered. Businesses are concerned about arbitrary “cost shifting” through the “tax” that hospitals and other providers place on people with insurance in order to treat the uninsured. This presently is done without any planning, oversight or coordination and there is no measure or gauge of its effectiveness or value. It might be possible to organize this stream of support by assessing a fee on health plans and hospitals for the orderly and organized provision of care to the uninsured children of the community. If the state has problems making Medicaid work, and employers complain about cost shifting, we should try to develop a way to make the market inefficiencies more effective. 

Childhood health access is not solely a problem of the indigent, the minority, the immigrant or the unemployed. There is a larger and growing pool of “underemployed” and “underinsured” in our community, and their children live next door. We pay for them when they are acutely ill and we should address ways to keep them well. Any effort to coordinate resources would improve what is now a system that fails many.