It’s an ill wind that blows

As the economy winds down, the cost to business

for providing health coverage keeps spiraling up.

Health-insurance costs for U.S. employers are rising — by about 6% this year, according to one consulting firm — and care is still hard to find in some parts of North Carolina. Hospitals compete fiercely for patients in places with affluent, fast-growing populations but shun many rural parts of the state. And the quality of care isn’t always what it should be. Haywood Regional Medical Center in Clyde temporarily lost federal Medicare and Medicaid reimbursements in 2008 because of faulty procedures for dispensing medications, and other Tar Heel hospitals endured uncomfortable examinations of their practices. Bob Greczyn is CEO of Blue Cross and Blue Shield of North Carolina, the state’s largest health insurer.

BNC: What effect will the recession have on health care?

Greczyn: We’re seeing layoffs. When people get laid off, they often lose their health-care coverage. Hopefully, we’ll see the economy turn around after the middle of this year.

When will the cost spiral stop?

There’s a structural annual cost increase built into health care because of new technology, the aging of the population and new treatments. Part of what’s going on is that employers are trying to continue to offer coverage, balancing between how large the co-pays or the deductibles are versus the total cost of the benefit plan. I don’t see that changing in the near term.

Do you foresee mandatory wellness plans to get employees to manage their health better?

It’s hard to make it absolutely mandatory. At Blue Cross, in order to get a portion of the employer contribution to your health-care coverage you have to go through a medical screening and engage in a wellness activity — pretty much anything — and you have to fill out a health-risk assessment form. We’re strongly encouraging people to improve their health. Employers have an important role to play.

The large health-care systems seem to be getting larger.

I don’t really see consolidation slowing down, but some of these large health-care systems are putting off construction projects. A lot of that is due to their inability to get bond financing.

How do you respond to consolidation?

One thing we’re trying to focus on is a project with the North Carolina Center for Hospital Quality and Patient Safety and the North Carolina Hospital Association to make the state’s hospitals the safest in the U.S. over the next few years. We’re also focusing on what we call centers of excellence, a designation we give to hospitals or health-care systems that meet our nationally developed criteria for things such as bariatric surgery or cardiac care or special cancers. The program focuses on good outcomes for patients, with the notion that the best outcomes usually come with the lowest cost.

Does the state do an adequate job of managing which hospitals get equipment?

With certificates of need, the beauty is in the eye of the beholder. Some people think they’re a wonderful thing and absolutely necessary. Some think it’s a process that’s driven less by need and more by the idea that if you invest enough time and legal work in it, eventually you get the outcome you want. I try to stay out of that debate.

How can the state improve rural care?

It’s hard. Whatever services are being provided in whatever part of the state, they need to be supportable. There are places where the hospitals have moved away from being general hospitals and are more focused on intervening during critical events and then transporting patients to larger institutions. Not every community in the state may be able to support a general medical-surgical hospital, and not every community is going to be able to recruit enough surgeons or enough of a particular type of physician to make it feasible to provide all services in every community.

What can be done to get physicians to practice in underserved parts of the state?

The medical society’s community-practitioners program has very successfully recruited physicians into some of the more rural parts of North Carolina in exchange for paying part of their medical-school debt. About 60 to 70% of the folks that were placed in a community stayed there. Availability of primary care is still a problem. We are talking about expanding the medical schools in North Carolina, and that’s part of the solution. But we also have to look very hard at residents’ programs, where physicians are trained, and changing the payment system so that we can encourage more people to go into primary medicine.

Are there other health-care fields with shortages?

One that we see is graduate-level nurses. If you don’t have enough of these graduate nurses, it makes it difficult to establish a credible program to train registered nurses.

What changes are likely at the federal level?

I’d support universal health coverage. The challenge is always how you get there. The first opportunity is the expansion of the children’s health-insurance program, and North Carolina’s already doing a great job with that. You could probably solve the problem of the uninsured just by getting the people already eligible for S-CHIP, the State Children’s Health Insurance Program, and Medicaid enrolled.