Freeloaders destroy Detroit hospital

Her legs crippled by diabetes, Mary Lewis is grateful it's a short distance between her doctor's office at Riverview Hospital and the adjacent apartment tower where she lives. It will become a painful struggle next year when the hospital closes and physicians' offices are forced to move. The hospital last week said it was losing too much money and already stopped accepting inpatients, though the emergency room will remain open for now. Because roughly 90 percent of its 11,000 annual inpatients are covered under the Medicare or Medicaid public assistance programs, Riverview has struggled economically, said Bob Hoban, a senior vice president for St. John Health, Riverview's parent company.

Experts say Riverview's decision to close fits a distressing, decades-long pattern of hospital closures in older cities across the nation. The trend has left large swaths of predominantly poor, black neighborhoods in cities such as St. Louis, Philadelphia and Cleveland underserved. Many say the loss of medical facilities for low-income patients is increasingly leaving overcrowded emergency rooms to double as primary-care centers. "This hasn't been happening in the suburbs and it isn't happening in Phoenix, Arizona, where they can't build hospitals fast enough," said Bruce Siegel, a research professor at the George Washington University Medical Center in Washington, D.C. "This is occurring in older, urban inner-city areas."

New York City, Philadelphia and parts of New Jersey have seen waves of hospital closings in inner-city neighborhoods, said Siegel, who directed a 2004 report examining the phenomenon for the Robert Wood Johnson Foundation. But few cities have been hit as hard as Detroit. The number of hospitals in the city has dwindled to seven or eight from 42 in 1960, said Alan Sager, director of the Health Reform Program at Boston University's School of Public Health. Hospitals that are larger, have major medical school-affiliated teaching programs and more money in the bank tend to survive.

Siegel's report warned that Detroit's safety net was already in a "fragile" state and could collapse entirely with further hospital closures. It said Detroit had lost more than 1,200 hospital beds with the closure of four hospitals since 1998. "Some of it is population shifts and declines," Siegel said. "There's (also) more and more people without health insurance and Medicaid payments that don't keep up with the cost of providing care."

Riverview, a community hospital with 285 beds, specializes in general medical and surgical services, such as treatment of congestive heart failure, diabetes and obstetrics. The hospital finished its last fiscal year with a nearly $9.5 million deficit and expects to end this fiscal year $23 million in the red. Medicare payments to hospitals averaged 92 cents for every dollar spent providing care in 2005, the most recent figures available, according to the American Hospital Association. Medicaid's reimbursement rate was lower, at 87 cents per dollar.

Officials at other area hospitals have complained that Riverview's closing will burden them. "We're 90 percent full on average and there are many days where we're 100 percent full," said Nancy Schlichting, president and chief executive of Henry Ford Health System, which has a trauma center hospital in Detroit.

Karmanos Cancer Institute plans to spend $20 million to renovate the 20-year-old Riverview and reopen it as a clinical center next year.

But Lewis is concerned her doctor's office will be forced to move too far from her home. "I'll have to find another doctor," the senior citizen said. While waiting for a bus after a physical therapy appointment, Mary Sanders said Riverview is the closest hospital for residents of the east side, including many disabled senior citizens. The 54-year resident of the neighborhood said she doesn't know where she'll go once the clinic closes. "Point blank, we need this hospital," she said.

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New contract leaves another 1.4m without an NHS dentist

The NHS asks us to believe that over a million fewer people had dental problems last year. What a triumph for preventive medicine! (If you believe it)

A controversial new cash deal for dentists has left 1.4million more people without NHS treatment - and a 120 million shortfall in income. The contract was introduced 11 months ago to stop dentists charging for each procedure and to promote a more preventive approach to patient care. It prompted an exodus of 2,000 dentists from the NHS and assurances from Ministers that every patient who lost an NHS dentist would be taken on by another.

Now figures collected under the Freedom of Information Act from 152 primary care trusts in England show a sharp reduction in the amount of NHS work being done. For the first nine months of the current financial year, 51.8 million Units of Dental Activity were delivered - a figure that falls short of what the Government said was needed to maintain levels of NHS dentistry.

In 2005-6 around 24.7 million people received NHS dental care, but - calculated from the latest treatment figures - this will have dropped to 23.3 million. As a result, the income received by PCTs from patients paying NHS charges has fallen. They were expecting 541 million but will only receive 417 million.

One reason could be that "an increasing number of patients are moving to private treatment", says the Department of Health's own primary care contracting group. There are also reports that up to a quarter of NHS practices are treating too many patients too quickly, and are now being told to delay treatments until Easter.

Tory health spokesman Andrew Lansley, who obtained the figures, said they were the latest miscalculation on NHS staff contracts. Other contracts that went over budget was the GP pay and conditions deal which exceeded estimates by 407 million; the Agenda for Change contract for hundreds of thousands of workers 220 million) and the consultants' contract 90 million), he said.

Mr Lansley said: "Eight years ago, Tony Blair promised everyone would have access to an NHS dentist but in the last year, 1.4 million fewer people have access. "NHS dentistry has reached this crisis point because Labour wanted to milk dental patients through higher charges. We need a contract that will incentivise NHS dentists to see more people. One that supports a relationship between individuals and their dentist and promotes good oral health."

Susie Sanderson, Chairman of the British Dental Association's Executive Board, said: "The BDA is aware that dentists and patients across the county are experiencing significant problems with the Government's target-driven reforms to NHS dentistry. "From our own research, we know that three-quarters of dentists felt that the contracts they were allocated did not accurately reflect the amount of treatment they are able to provide. "Where patient charge revenue shortfalls are occurring, the BDA is concerned that they must not be allowed to impact on the provision of patient care."

The Department of Health said: "This survey paints a picture that we do not recognise. We do not accept that 1.4m fewer people have access to NHS dentistry. Widely available figures show that access has remained remarkably stable. "Equally it is nonsense to talk of a shortfall in investment. PCTs have put more money into dentistry than they needed to do and the access figures show this is translating into services for patients."

In March last year, Health Minister Rosie Winterton said the vast majority of dentists were signing up to the new contract. She said: "If dentists choose not to sign up, the local NHS will use that funding to buy services from other dentists."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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