In El Dorado County, the average cost of a hospital stay for a public employee is $7,373 a day. Statewide, the average cost is $4,825 a day for the health plan covering the California Public Employees Retirement System, or CalPERS.
What's up?
The high cost of providing health care in El Dorado County can't simply be explained by higher transportation costs or high electricity costs. In many rural markets, the hospitals and doctors behave like the monopolies they are, and charge for services accordingly. So long as an entity such as CalPERS is forced to pay, the monopoly lives.
A key health plan for CalPERS, Blue Shield, is proposing to abandon its HMO in four of the most expensive counties -- El Dorado, Napa, Lake and Plumas. Understandably, the counties want CalPERS to delay, defer or abandon the idea. In essence, however, they are asking public employees who live in urban areas to subsidize the costs in monopolistic rural areas.
That doesn't seem fair. Rather than focusing its political efforts on Cal-PERS, these rural governments should be asking their own health care communities about the high costs and how to contain them.
Sometimes -- not always -- a problem with rural health care has to do with a local pattern of medical practice. Back in 2001, for example, Redding residents faced a similar reduction in health insurance options. A respected Northern California medical group, Hills Physicians, had been trying to provide cost-effective services in the community, but the problems were enormous.
Local doctors working for Hills Physicians demanded higher fees than their counterparts in the more-expensive Bay Area. Even more troubling, the physicians were performing many more procedures. A Redding woman, for example, was two times more likely than a Sacramento woman to undergo a hysterectomy -- and four times more likely than a woman living in the East Bay.
The message at the time from Hill Physicians' leader to the Redding doctors, delivered in person, was blunt: "Your behavior is bad for the health of this community."
Today, for CalPERS, it would be financially healthy for the system to stop providing HMO-style health care in the four rural counties. The savings in premiums would be $30 million. Ideally, public employees in El Dorado should have a similar array of health plan options as employees living in the urban flats. But reform needs to start at home. El Dorado governments should be wondering why their health care is so much more expensive than the norm and trying to do something about it.
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Published 12:00 am PDT Monday, April 23, 2007
Story appeared in EDITORIALS section, Page B4
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