Author Archives: James Campbell

Addressing Native American Health Disparities

American Indians and Alaskan Natives continue to have worse health outcomes and a wide mortality disparity compared to the rest of the United States’ population. This includes higher rates of heart disease, cancer, diabetes, alcohol addiction, suicide, sexual assault and a life expectancy of five and a half years lower than all other racial and ethnic groups in the United States. Why is this, and what are the possible solutions policymakers are proposing to address these disparities?

Historical trauma through colonization and federal laws such as the Indian Removal Act led to generational trauma and contribute to present-day health disparities. The United States Commission on Civil Rights has attributed “the failure of the federal government to adequately address the wellbeing of Native Americans over the last two centuries” to these health disparities. These generational traumas are developed through continued suppression of indigenous cultures and a long-term lack of resources dedicated to addressing these disparities. The Indian Health Service, which is supposed to fulfill the United States’ treaty obligations to provide healthcare for American Indians and Alaskan Natives, is consistently underfunded. In 2013, only fifty-nine percent of the projected need for the Indian Health Service was funded, demonstrating a severe lack of priority for addressing Native American health disparities. The National Congress of American Indians has called on Congress to commit an additional $2 billion per year to address this funding gap.

The IHS needs to receive more funding, but also needs to diversify where services are provided. The majority of Native Americans live in urban areas because of federal government relocation policies following a history of colonialism. Native Americans in both urban and rural areas need access to IHS services, and the increase in funding can go to addressing the needs of these geographically separate populations. Increased funding is only one part of the solution—addressing mental health outcomes continues to be one of the most persistent problems among Native Americans and Alaskan Natives.

Solving this problem not only includes advocating for more mental health providers in traditionally underserved areas but also, as one study found, that “participation in traditional cultural activities” is associated with positive mental health outcomes. The United States can encourage positive mental health outcomes by respecting tribal sovereignty and recognizing traditional cultural practices. Tribal governments should be partners in addressing these disparities and respecting traditional cultural activities and sovereignty must be part of the solution. Tribal governments are leading the way with innovative solutions to bring low-cost and high-quality healthcare to their members. Partnering with state governments to create new and collaborative programs often combine the expertise of tribal governments with funding from programs like Medicaid and have the potential to lead the way in addressing these disparities.

Addressing these health disparities also calls for addressing the persistent issue of sexual violence and missing and murdered indigenous women. Even the IHS is facing allegations of sexual abuse that resulted in a civil suit. The first steps to address this issue include a presidential task force dedicated to studying and producing a report as the full-sight of the problem has yet to be understood. Additionally, Congresswoman Deb Haaland—one of the first Native American women elected to Congress—has introduced multiple bills to address this issue. These bills include the Not Invisible Act of 2019, the SURVIVE Act, the Justice for Native Survivors of Sexual Violence Act, and provisions to address sexual violence against Native women in the Violence Against Women Act reauthorization. While the federal government takes these important first steps, and leaders like Congresswoman Haaland introduce bills aimed at ending sexual violence against Native Americans, ending health disparities will take a coordinated and deliberate effort. Tribal, federal, and state governments must work as partners to draw down health disparities and coordinate their efforts to make sure long-term gains are addressed. It will take acknowledgment of historical trauma, new funding and innovation to ensure that Native Americans and Alaskan Natives receive the high-quality care that they are owed through historic

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Hospital Mergers: Impacts on Patients, Pricing, & Antitrust Concerns.

Over the past year, mergers and acquisitions across industries are seeing a spike while appropriations to the antitrust division of the Department of Justice have remained the same. Included in this most recent spate of mergers are hospital systems. Hospitals are merging at record rates and PricewaterhouseCoopers predicts hospital system mergers to continue to grow. As hospitals continue to merge, they have started to form new conglomerates in the healthcare industry. One recent example is the merger between Catholic Health Initiatives and Dignity Health, forming CommonSpirit Health.

CommonSpirit Health has sites across 21 states, 150,000 employees and over $30 Billion in revenue. With 90 percent of Metropolitan Statistical Areas considered highly concentrated for hospitals as of 2016, these mergers beg the question of whether patients are benefitting. Furthermore, what are the anti-trust implications of highly consolidated regional hospital systems?

A new study from the American Hospital Association claims “hospital acquisitions are associated with a statistically significant 2.3% reduction in annual operating expenses at acquired hospitals.” The American Hospital Association suggest that by combining administrative functions among hospital systems they can pass these savings onto patients. However, a recent class-action lawsuit against Sutter Health disputes this notion. Sutter Health – a Northern California health system – is accused of using its market dominance to drive up the cost of services. With such a high level of regional market control, hospital systems like Sutter Health use “all-or-none” contracting with insurance companies to demand higher prices for services. These costs trickle down to patients with higher premiums and co-pays.

Patient advocates attribute the Sutter Health lawsuit to lax anti-trust practices when it comes to hospital mergers. While anti-trust officials have the time and resources to focus on blockbuster industry mergers such as CVS-Aetna, smaller mergers among regional hospitals and healthcare service providers go unnoticed. An example of such mergers is Anne Arundel Medical Center and Doctors Community Health System merging to form Luminis Health in Maryland. These regional mergers often evade the eyes of regulators and patient advocates warn of their potential to drive up costs by dominating regional markets and rarely if ever lower costs.

An industry-funded study [ST1] from Deloitte points out, however; that mergers and acquisitions in health systems lead to investments and improvements on acquired facilities and lower operating costs. This same study also pointed to specific improvements in patient reducing patient mortality, reducing wait times and reducing readmissions. These are all factors anti-trust officials should consider when deciding whether to challenge a merger. Anti-trust officials simply don’t have the resources to analyze these deals;leaving patients footing the bill for increased costs. Hospital costs continue to remain the largest overall share of healthcare spending in the United States. To lower healthcare costs and improve patient outcomes, it is time for regulators to examine these regional health system mergers and their vast implications on patient outcomes and pricing.

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