Sunday, January 22, 2006
By COLETTE YAMAGUCHI Columbian forecaster

Among the most visible 2006 Clark County health care trends will be the continued expansion of facilities to serve the county's rapidly growing population.

Last year the county's (and state's) first new hospital in decades, Legacy Salmon Creek Hospital, opened near the interchange of Interstate 5 and 134th Street. This year will see continued construction as the county's other major hospital, Southwest Washington Medical Center, adds a new hospital wing, set to open by year's end.

Growing population has prompted Kaiser Permanente to locate four of its nine new outpatient medical offices in Clark County just since 1989. This summer, the health care organization will open another medical office in the Orchards area. The $24.2 million two-story facility will serve the many families and individuals attracted to northern and eastern Clark County by the availability of more affordable housing and good schools.

Kaiser expects its Southwest Washington membership, now at more than 100,000, to continue growing as many of those families and individuals opt for convenient care with physicians, pharmacy, lab, nurse treatment and X-ray services all under one roof.

Partnering trend

Perhaps less apparent but still vitally important is a trend toward greater partnering between and among health care organizations, employers, public agencies, and citizens to address basic health issues facing the county.

Kaiser Permanente continues to support efforts such as Community Choices 2010 that look at ways the community as a whole can influence factors affecting health. This broad approach recognizes that residents' health is affected by everything from how many kids drop out of school to how many jobs paying family wages and benefits are available.

In addition to working to lower smoking rates and teenage pregnancies, look for such groups to tackle emerging health problems, especially the rise in obesity across all ages and ethnicities within the county. For example, Kaiser Permanente is funding a walking map of the county to be distributed later this year. It's also funded the Kids on the Block puppet troupe to expand performances of its healthy eating, healthy activity show in Clark County schools.

Kaiser Permanente will also again be part of a coalition of public and private organizations in Clark County that will urge parents to consider the detrimental impact on their children from too much television and computer screen time. Research shows that every hour spent sitting in front of a TV or computer adds to children's risk for being overweight. Coalition members will encourage active play, reading and healthy socializing to prevent a host of obesity-related health conditions in children.

Costs going up

Expect health care costs to continue to rise in 2006. The U.S. is hurtling toward spending $2 trillion dollars a year for health care. Although not going up at quite the pace of recent years, double-digit increases in health care costs nationwide will also be an issue for Clark County businesses and residents. That's because the same pressures -- from promising but expensive new drugs and treatments to higher costs for skilled health care professionals and information technology -- will continue in the coming year to force health care costs up.

The National Coalition on Health Care has predicted that in 2006 the average cost for family coverage in the U.S. will be more than $14,500. At those prices, more and more employers are likely to be tempted to shift some health costs to their employees, a trend that has accelerated as competition from low-wage countries has bitten into profit margins.

This cost-sharing often takes the form of higher co-payments and bigger deductibles. Some employers are also dropping coverage for dependents and/or spouses, or sharply reducing the employer's share of coverage for family members. Others are slashing benefits.

What does that mean for Clark County? In the long run it could cost us all more.

Besides having less income to spend on goods and services, greater out-of-pocket medical care costs can lead to financial stress for even the middle-class. According to a USA Today story last year, a recent Harvard University study found that half of all bankruptcy filings were partly the result of uncovered medical expenses. The average out-of-pocket medical debt for those filing bankruptcy was $12,000. Already 45 million Americans have no health coverage of any kind. Health care costs could get worse as they and more and more underinsured people forego or delay routine and preventive care until problems reach a crisis. Inevitably, the unmet cost of treating those crises gets passed along to the rest of us in taxes and insurance premiums.

The outlook for 2006

* The National Coalition on Health Care has predicted that in 2006, the average annual cost for family health care -coverage in the U.S. will be more than $14,500. Double-digit cost increases are expected to continue.

* Capital expansion in Clark County's health care industry will continue with new hospital beds coming on line, more clinic capacity and industry employment increases of an as many as 600 new jobs

* Expect more partnering among local health care agencies- and businesses to expand community health-related education and service programs.

Expansion at Southwest Washington Medical Center is among several health care capital projects under way in Clark County.

HEALTH CARE: What might happen 20 years from now

If rising health care costs are a concern today, in 20 years they are likely to be a crisis. As much as $1 in every $5 spent in the U.S. may be going to health care two decades from now. Yet in measure after measure, Americans don't seem to be benefiting from dramatically better health than nations that spend far less on health care. In fact, for infant mortality rates and childhood immunizations, the U.S. scores significantly worse.

So what's driving us toward a growing health care crisis? Three factors stand out.

First, the aging of the population. The average age in the U.S. is rising. By 2030 the average age will be almost 40 -- up from the current 36 years. The ratio of working age Americans per senior citizen, aged 65 and older was six to one in 1960. By 2030 it will have fallen to just three per senior citizen. Nationwide, there will be 69 million people older than 65 in 2030, representing 20 percent of the total population.

Because we use more health care services as we age, the nation as a whole will need to spend more on health care. Because health care professionals are also aging, we will see large numbers retiring over the next 20 years. With static or declining numbers of replacements being trained and no national training plan in place. We can expect today's shortages of selected health care workers to broaden and worsen, forcing labor costs higher.

Health care organizations will need to redesign work to rely less on scarce health professionals. This could be everything from encouraging patients to e-mail routine questions to a health professional to offering patients with the same condition a longer educational visit in a group, such as the popular group appointments Kaiser Permanente holds now for people with diabetes.

Secondly, we can do more for people now than ever before. We have more medicines, more vaccines, more procedures and more diagnostic tests. Some of these are more effective than what was available in the past. Many, however, aren't demonstrably better at improving health than existing drugs or tests, yet cost far more.

As the Baby Boom generation ages, expectations for what medicine should be able to do to keep them healthy and active will certainly drive up demand for tests and treatments. Being able to carefully and objectively evaluate new medicines and technologies and share that information with patients so they know what is helpful and what isn't will be even more important if costs are to be kept down and patients kept safe.

Kaiser Permanente New Technologies Committee has already pointed the way with multi-disciplinary teams that scrutinize the science behind newly introduced medications, devices and treatments.

Finally, huge investments in information technology to replace the antiquated paper-driven systems in medicine will add to health care costs over the next 20 years. Although essential to improving patient safety and determining what health interventions work and what don't, there are large up-front costs in hardware, software and training.

So in the future, health care must get the right treatment to the right patients at the right time, and in innovative ways that best fit with patients. For their part, patients will need to become better educated consumers about their health and the increasing medical options that will be aimed at them. They should demand better evidence that what is being done for them will actually make a real difference in their health. This will need to be coupled with greater acceptance that how we choose to eat, exercise, and interact with others plays a huge role in how healthy we'll be.