Even before President Clinton's ideas for health care reform were
brought to the nation's political agenda, it was clear to most in
industry that the cost and methods of providing medical care to our
country's citizens had gotten out of control.
But the idea of growth and competition among the health care
industry -- even if it possibly meant the reduction of those costs
and greater effectiveness of the service -- has sparked controversy,
depending on which provider or legislator you talk to.
State and federal governments have tried to establish regulations
and even lofty national health care systems to control costs and
create efficiency, but nothing has worked to date. And for many
health care organizations, this has meant the opportunity to rethink
the way health care is delivered in this country and possibly run it
the way successful businesses in America have operated for years.
These days, every hospital and health care system has to run on a
fiscally responsible basis, in order to reinvest in its facilities,
update technology, and pay its employees. The growth of managed care
and capitated fee-for-service has caused everyone in this industry
re-evaluate their costs. Even the tax-exempt hospitals, which didn't
have to worry about financial accountability in the past, are
that they need to be more prudent in their spending and efficient in
An integrated health care delivery system that can control costs
through large vendor contracts, networked medical information and
shared resources of numerous hospitals and facilities working
together, means efficiency and quality patient care.
Hospitals and health care systems that attempt to compete in this
new world of patient care by running their operations more fiscally
responsible have met with criticism from other health care systems,
hospitals and certain public officials who see their growth as a
threat to "business as usual" in a changing world. Even when met
with the reality that government intervention to control costs
worked, these critics still search for ways to improve health care
efficiency without changing much of the traditional methodology.
These past attempts on the part of government to control costs
haven't worked. In the 1970s, the government attempted to slow the
growth of health care costs by limiting the number and geographic
distribution of health care facilities, equipment and services by
enacting Certificate of Need (CON) regulations in each state. In
1974, the National Health Planning and Development Act was enacted
Congress, which required states to establish and administer CON
regulations as part of the overall health planning process.
This attempt failed over time. In 1982, when Congress realized
that CON had failed to meet its health planning and cost containment
objectives, the CON requirement was repealed. Since then, 17 states
have totally repealed CON programs and several others have removed
CON requirements for hospitals. Oklahoma was one such state to
remove the hospital portion of the CON requirement.
A recent attempt in Oklahoma by one state senator to re-establish
CON requirements in the state has been tabled thus far. The Oklahoma
Hospital Association has gone on record as publicly supporting the
continued repeal, so it looks as though, for the time being,
Certificate of Need is still not the answer for controlling the cost
of health care in Oklahoma.
CON aside, critics of systems attempting to grow in this state are
still wary of expansion. These critics are doing a disservice to our
state's citizens, however, by perpetuating myths that are not
accurate. The idea of competition in a free marketplace is a sound
one which is the very backbone of our country's economic system.
Competition makes us stronger, provides more choice and greater
quality for the consumer, and brings out the best potential of each