Re: Hospital Consolidation

["Lois Melina" <lmelina@moscow.com>]

John,
Are you making an assumption that Gritman would have to expand if it
incorporated Pullman patients? I'm not sure that's true.

Aside from that...
It seems to me that one of the underlying impediments to resolution of this
issue is that of "community." Residents of Moscow and Pullman do not want to
travel to the other town for much of anything, but particularly for services
that we traditionally associate with "community." I think part of it is the
commute, but I suspect it goes deeper than that. We want to have schools,
churches, medical services, and grocery stores in our own communities.
Otherwise, I think we like we aren't really self-sufficient; we are
dependent. A healthy community, like a healthy family (we think) should be
able to meet its own needs. To "lose" a hospital, or a high school, or a
major employer is to feel diminished as a community.

While I think that factor is an important part of public support in the
debate over hospital consolidation, I wonder to what degree it is included
in the decision-making. (In other words, do the hospital boards discuss the
impact on the community psyche, or just the financial considerations?)

If my analysis is correct, how could this dilemma be resolved so that
neither community feels diminished or dependent, or how could a paradigm
shift regarding "community" be accomplished?

Lois Melina
whose thoughts on hospitals are her own and do not necessarily reflect the
thoughts of health care personnel with whom she may be associated

-----Original Message-----
From: John and Laurie Danahy <JDANAHY@turbonet.com>
To: vision2020@moscow.com <vision2020@moscow.com>
Date: Friday, December 17, 1999 9:29 AM
Subject: Hospital Consolidation


>Based on what I have read and heard, it seems to me that there are two
>issues to be debated.
>
>First is should the two communities consolidate the regional medical
>facilities into one in the corridor at a cost of $34 million dollars.
>Certainly Pullman needs to replace its failing facility.  Unfortunately,
>local voters turned down bonds that would have provided relief from their
>current situation.  Moscow does not need to replace its current facility,
>however, expansion seems to be severely limited unless Gritman can purchase
>more of the downtown area.
>How to finance a proposed merged medical facility in the corridor has not
>been fully explained.  Gritman is a non profit private enterprise, as such
>it has, I believe, no taxing authority.  Any part of the $34 million it had
>to pay would have to come from somewhere.  Pullman apparently does have
some
>taxing authority and can ask for financial help from its voters.  The two
>states have very different tax based structures and I do not see how we can
>create a merged financial package that is fair to all.  Also a merged
>facility in the corridor presents transportation concerns to all.  From my
>perspective, the city of Moscow would soon see bypass roads developed so
>patients could get to the merged facility without having to traverse
>downtown Moscow.  This creates secondary negative impacts to the downtown
>community.
>The idea that the two communities merge into Gritman seems to have merit up
>front.  Pullman however, does not want to transport across the corridor and
>really does not want to lose some of its identity.  Clarkston is a separate
>city, but often seems a suburb of Lewiston.  Pullman does not want to end
up
>the same.  Again too, Gritman would need to expand its facility, something
>that at present it is unable to do, unless it creates a satellite facility
>in another location, but then we are back to the $34 million dollar
>question.
>
>The second issue that has surfaced is the questions of a group of local
>doctors building a private out patient surgical facility in the corridor.
>This facility would offer lower cost out patient surgeries, be run as a for
>profit private enterprise, and give the medical professionals some freedoms
>in their practice.  This would operate by taking the "cream" of local out
>patient surgeries from the local hospitals, offering them at a "lower cost"
>since they would not have to subsidize higher cost surgeries, leaving the
>hospitals with no choice but to raise charges for what is left.
>At first glance, this seems to be a neat idea.  It would create
competition,
>and lower medical costs to consumers, but I remind everyone of Robert
>Heinlein's TANSTAAFL  There ain't no such thing as a free lunch.  Lower
>costs for some out patient surgeries just means higher costs for others.  I
>would also wonder how the medical insurance industry would view this.
>Having some experience crossing state lines with insurance companies, it
>does seem to severely complicate an already complicated system.
>
>Just some thoughts
>
>John
>
>John and Laurie Danahy
>jdanahy@turbonet.com
>>
>