Introduction and Purpose

Hospitals either are on the brink of financial collapse, successfully recovering from severe negotiated discounts, have emergency room backups, or are over-bedded. What policymakers hear about the health of our hospitals seems to depend on whom they talk to or where they live. These diverging perceptions can make it difficult for policymakers, including State and local health officials, to identify and understand what problems really exist, or how they might be addressed.

State and local governments play a critical role in paying for hospital care, regulating the hospital industry, and, in some cases, owning and operating hospital facilities. It is, therefore, important that public policymakers understand the dynamics affecting hospitals within their jurisdictions in the broader context of national trends, available health services research findings, and State and local policy activities.

The following emerging issues present an image of an industry buffeted by a range of forces which can leave policymakers with a cloudy picture of the current situation as well as the future of these institutions:

• Hospital care utilization and spending has been on a roller coaster ride. Throughout most of the 1990's, reductions in the rates of growth for inpatient hospital spending was responsible for much of the slowdown in health care spending during that period. More recently, however, hospital spending has contributed to a dramatic surge in health care cost inflation, with hospital spending accounting for the largest portion — 51 percent — of medical care cost increases in 2001.
  
  
• Has the balance of power shifted? After feeling squeezed for more than a decade by managed care plans, many analysts now see hospitals gaining the upper hand in negotiations with health plans and asking for, and receiving, better rates. Recently, the Federal Trade Commission announced its intention to increase scrutiny of past hospital mergers to ensure that they did not occur simply as a strategy for increasing prices.
  
  
• Hospital overcrowding is an increasing concern. The public is becoming increasingly concerned that they might not get emergency care when they need it. A recent survey by the American Hospital Association found that 90 percent of large hospitals reported being "at" or "over" capacity for treating patients, while one in three emergency rooms are so crowded that ambulances are sometimes diverted to other hospitals.
  
  
• Hospital uncompensated care continues to be a "chronic" problem. While the overall costs of hospital uncompensated care have remained relatively stable over the past several years, there is recent evidence that the burden of providing this care may be falling upon a smaller number of hospitals. Policymakers across the country continue to explore creative approaches to support and more equitably distribute the burden of providing this care across hospitals.

The key questions policymakers and program administrators have been asking are:

• What are the national trends in the healthcare marketplace affecting hospitals — e.g., trends in inpatient and outpatient utilization, the emergence and growth of alternative sites of care — and what has been their impact on hospitals' financial status and viability?
  
  
• How big is the problem of hospital emergency room overcrowding and ambulance diversion nationwide? What are the factors that have contributed to these problems? What strategies are individual States, communities, and/or facilities implementing to address these problems and how effective have they been?
  
  
• What are the trends in the provision of hospital uncompensated care to uninsured and underinsured individuals? What is the financial impact on hospitals that provide such care? What approaches are States and communities taking to support the provision of such care and to ensure a "fair" distribution of the uncompensated care burden across hospitals?

Event Schedule

In order to help State and local officials address these and other important policy-relevant questions, AHRQ's User Liaison Program offers this series of three Web-assisted audio conferences:

Intended Audience

These Web-assisted audio conferences will be particularly valuable to a wide range of State and local officials who have responsibility for making health care policy or administering health care programs. These officials would include State legislators and their staff, Governors' offices, senior officials within health departments, hospitals, Medicaid agencies, employee health benefit programs, budget and insurance commissioners' offices, and local policymakers.

Web-Assisted Audio Conference Format

Each 90-minute Web-assisted audio conference will address a different set of challenges for hospitals, and State and local policymakers. Each event will feature a panel of experts in the field who will answer questions from the audience via fax, phone, e-mail, or online throughout the Webcast. The calls will be moderated by a former health and science journalist and TV news anchor. Participants are welcome to register for single or multiple sessions.

The audio conference will be available as a Webcast as well as in a conventional audio teleconference format. Presentation slides, audio, and an online question and answer session will be provided through the Webcast. Simultaneously, the audio portion of the program will be available by phone for participants who prefer to use their telephones instead of their computers.

Participation is FREE!

There will be no charge for participation, but we would appreciate feedback on the usefulness of this format for sharing up-to-the-minute information on the topics that most concern you in health care delivery and policy. Please invite your colleagues to join us for any or all of the calls.

Sponsor

This series of Web-assisted audio conferences is sponsored by the User Liaison Program (ULP) within the Federal Agency for Healthcare Research and Quality (AHRQ). The AHRQ is an agency in the U.S. Department of Health and Human Services. AHRQ's mission is to support research designed to improve the outcomes and quality of health care, reduce its costs, address patient safety and medical errors, and broaden access to effective services. In addition to its primary mission of supporting and conducting health services research, AHRQ translates and disseminates its evidence-based findings, providing State and local policymakers with information and tools they can use to make more informed decisions about health care.

How to Register

Click on the button above to register for any or all three of the Web-assisted audio conferences. You must register at least three business days before the first event if you are registering for all three events, or three days before a specific event if you are not registering for the full series. You will receive an automated e-mail confirmation (or a fax confirmation, if you register by fax) that includes the Web address, toll-free number (if accessing audio by phone), and access information for joining the audio conference.

If you have additional questions about registering for these Web-assisted audio conferences, you may contact Maureen Ball, the ULP contact at Health Systems Research, Inc. (AHRQ's contractor for the audio conference series) at 202-828-5100.

...Bridging the gap between researchers and policymakers...

- 2101 East Jefferson Street, Rockville, MD 20852
- ULP Telephone: (301) 594-6668, Fax (301) 594-2035
- E-mail: ulp@ahrq.gov