February 12, 2003
Washington state;s health system ‘is in trouble,’ report says
“Washington’s health-care system is in trouble,” says a study released by the Health Policy Analysis Program (HPAP) of the University of Washington. The 2002 Pulse Report reveals that major trends such as health-care provider shortages, health insurance premiums, and the percentage of people without health insurance have been heading in the wrong direction — up — since 1999.
HPAP has been tracking major indicators of Washington’s health system since 1997 as part of its Vital Signs of Washington’s Health Initiative. The 2002 Pulse Report tracks national, state, and local data to address three primary questions about Washington’s health system:
– Are people in Washington getting the health services they need?
– Do people have health insurance and where do they get it?
– Who pays for health services and how much?
Examples of trends covered in the report include health-care expenditures per capita, who pays for health-care services and in what proportion (government, business, individuals), and rates of health-care spending for different sectors (hospitals, prescription drugs, physician services, etc.). Significant trends highlighted in the report include:
Shortages of Primary Care Physicians and Nurses
In 2001, 38 of Washington’s 39 counties had federal designation as primary care health professional shortage areas, up from 23 counties in 1998. HPAP’s research reveals severe shortages in parts of Ferry, Pend Oreille, Spokane, Columbia, Benton, Franklin, Grant, Yakima, Clark, Pierce, King, and Skagit counties.
Nurses are also in short supply. The number of RNs per 100,000 people declined from 775 in 1996 to 738 in 2000; the national rate in 2000 was 782 per 100,000. Fifty-four percent of RNs in Washington were employed full-time in 2000, compared to 72 percent for the nation. In 2001, 66 percent of Washington’s urban hospitals and 46 percent of rural hospitals had to divert patients to other hospitals due to a shortage of nurses (not just RNs).
An Increase in the Uninsured
The percentage of uninsured increased from 8.4 percent in 2000 to 10.7 percent in 2002, according to data from the Washington State Population Survey. The percentage of uninsured in some rural areas is much higher, reaching 16 percent in Eastern Washington.
“The number of people without health insurance is likely to increase if cuts are made in the Basic Health and Medicaid programs to help balance the state budget,” says Patricia Lichiello, senior policy analyst and executive editor of the report.
Increases in Health Insurance Premiums
Per capita spending on health care in Washington remains below the national average and is increasing at a slower pace — two positive trends. However, health insurance premiums have jumped dramatically for private sector employers and government payers. Average premiums in Washington for private sector employee coverage increased 19.4 percent in 2000. Premiums for public sector health insurance are expected to increase 20 percent in 2003. In the individual insurance market, premiums have been rising by double digits each year from 1997 to 2001, rising almost 24 percent in 2001.
The 50-page report is available on HPAP’s Web site at http://depts.washington.edu/hpap/ and in two-color hard copy format for $15.
The Health Policy Analysis Program, based in the School of Public Health and Community Medicine, was established in 1974 to study the issues and public policy measures that affect the health of communities in Washington and the Pacific Northwest. HPAP policy analysts have published reports on a wide range of health policy areas including health-care costs, health insurance, managed care, access, and quality of care. HPAP’s reports and briefing papers are available at http://depts.washington.edu/hpap/. Funding for the 2002 Pulse Report was provided in part by the Washington Health Foundation.
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