5.20.03

MNA Points to Pending Closure of Waltham Hospital as Evidence of the Failure of the Market-Driven Health Care System in Massachusetts

Calls for Legislative Action to Prevent Future Closings of Needed
Hospitals To Guarantee Life-Saving Care to those in Need

CANTON, Mass. - The recent decision by the Waltham Hospital Board of
Trustees to close the 117-year-old community hospital represents a
failure of the market-driven health care system in Massachusetts,
according the Massachusetts Nurses Association, which represents more
than 22,000 registered nurses, including more than 200 working at
Waltham Hospital.

The closure will leave the citizens of Greater Waltham without access to
a health care safety net and will surely result in the needless death of
many residents because of a lack of access to appropriate life-saving
acute care services.

The crisis in Waltham is not an isolated one. The state's attorney
general is reported to be tracking six other hospitals on the verge of
closure. In recent weeks, Addison Gilbert Hospital in Gloucester has
been the focus of intense debate in that community as its parent
company, Northeast Health Systems of Beverly, is moving towards closing
beds and removing vital services from the facility which serves more
than 40,000 residents.

In both cases, the state has little power under current law to do
anything to protect the vital health care resources provided by these
community hospitals. If a hospital is to close, all the Department of
Public Health can do is call a hearing and determine if the facility
provides an essential service, without the power or authority or funding
to do anything about it.

"Let us be very clear, there are not enough acute care services to
adequately take care of the citizens of this commonwealth at this time,"
said Julie Pinkham. "At Waltham, we are now looking at taking away a
community hospital from a community of 60,000 residents, with another
100,000 people who work in that city on a daily basis. And replacing a
full service acute care hospital with an urgent care clinic, as has been
proposed, does not in any way represent a viable alternative to keeping
this hospital open. This is a hospital the Department of Public Health
deemed as an essential service, yet, still nothing is being done or it
appears can be done to protect these vital services for this community.
This is unacceptable."

According to Pinkham, what has happened to Waltham Hospital is the
inevitable result of a deregulated system where survival is based on
unbridled and unfair competition that has nothing to do with providing
appropriate care to people who need it.

The current system was created in the later 80's and early 90's as the
health care industry sought and the legislature agreed to deregulate the
system, allowing hospitals to compete openly and without restriction for
survival. In the ensuing years, more than 26 hospitals have closed and
massive regional networks built around tertiary care teaching hospitals
were created.

Deregulation was instituted under the rationale that competition would
result in the closure of unnecessary beds and inefficient hospitals,
resulting in significant savings and more efficient delivery of
services. The system has failed on all counts according to extensive
research of the industry conducted by Alan Sager at the Boston
University School of Public Health.

"After studying the causes of hospital closings in 51 U.S. cities, we
found that the market doesn't work. Community hospitals are likelier to
close - even though they're more efficient - in part because they lack
sufficient physicians (as was the case with Waltham Hospital). Teaching
hospitals and wealthier ones tend to survive," Sager explained.

According to Pinkham, "We have created a system where well funded
teaching hospital networks dominate the hospital industry, drawing
physicians, admissions and resources away from much needed and less
expensive community hospitals. Waltham Hospital is the latest loser in
this Darwinistic struggle for survival."

Careful Planning and Legislative Action is Needed

The MNA believes that the unbridled reliance on a deregulated health
care system must end and that the legislature and state government must
take steps to enact health care policies to stabilize the health care
system and the hospital industry in Massachusetts.

First, the legislature must begin the development and implementation of
a state health care policy that sets short and long term goals for
health reform in Massachusetts. State Sen. Richard Moore, Senate Chair
of the Joint Committee on Health Care, has begun this process.

Second, State Rep. James Marzilli (D-Arlington) and State Rep. Emile
Goguen (D-Fitchburg) have filed legislation, H. 552 and H. 1088, to
regulate Massachusetts hospitals to ensure the survival of needed
facilities to meet the health care needs of the state's residents. The
law would:

* identify which hospitals and hospital services are essential to
the health of their communities;
* identify hospitals in danger of closing or of changing services
in ways that could harm their communities;
* create a receivership law that would empower public officials to
petition a court to appoint a receiver to stabilize, conserve and
receive each needed but endangered hospital;
* provide technical assistance as needed to support the hospital's
survival; and
* create a dedicated trust fund, whose revenues would be generated
by an assessment on acute care hospitals' total revenue, as well as the
ability to access funds from the free care pool or other distressed
hospital funds.

Third, given the current budget crisis, and understanding the essential
core service that the health care system provides, it is also imperative
that the legislature act responsibly to explore avenues of generating
revenues to support the maintenance of the state's health care safety
net.

"We cannot meet the health and human services needs under the current
strategy of budget cutting as the only option. We need to raise revenue
or people will die," Pinkham said.

Finally, the MNA also believes that in addition to the hospital
stabilization bill, a much broader and fundamental restructuring of the
health care system must take place. The organization is one of a number
of health care and consumer organizations calling the passage of
legislation to create a single-payer health care system in the state.

"The bottom line is that the current health care system cannot be
incrementally 'fixed' without injuring patients. This patchwork system
is failing and the simple reality is it's much more cost effective,
efficient and fair to have a one-payer pool with one set of rules
covering everyone," said Pinkham. "If we don't proceed with major
reform now, we are going to find it much more expensive to have to
rebuild this collapsing health care infrastructure."

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