Health Care of the Poor

HEALTH CARE OF THE POOR

Pennsylvania Catholic Conference

A Call to the Catholic Church in Pennsylvania

The Pennsylvania Catholic Conference Task Force on Health Care for the Poor was formed by the PCC Administrative Board to deal with the growing concern for health care of the poor in our midst. The special focus of the Task Force was the development of a response to this concern by the Catholic Church in Pennsylvania as a whole, and especially by Catholic health care facilities. The Task Force has, as part of its role, made an effort to provide a guide for the Church in Pennsylvania to deal with those who need health care and medical treatment.

The Task Force, a broad-based representation of the Church, was convened to identify the nature of the problem in providing health care for the poor. In its work, the Task Force has identified various recommendations by which the Church in Pennsylvania can respond to its concern for those in need of health care and medical treatment. The Task Force relied in its deliberations and in the formulation of this Report, in part, upon excellent works and studies undertaken by, among others, The Catholic Health Association.ASSUMPTIONS

Basic to the recommendations in this Report are four assumptions:All persons are entitled to necessary health care and medical treatment which are basic human rights.The Church has, as part of its mission, a healing ministry which is Catholic health care, and which is the exemplification of Christ's healing ministry.A just health system is one which enables all persons to receive necessary services without regard for ability to pay.The socioeconomic and political environment in the United States today has not been receptive to focusing on the health needs of the poor and the near poor; it has been receptive principally to addressing cost containment policy.DEFINITION

The focus of the Task Force must be defined so that its recommendations can be fully appreciated and receive the widest practical application. The Catholic Health Association in its excellent work, No Room in the Marketplace, The Health Care of the Poor(2), developed a definition of the poor which the Task Force has adopted. Those to whom this report is principally intended to apply are:

"The poor who are unable through private resources, employer support, or public aid to provide payment for health care services, or those unable to gain access to health care because of limited resources, inadequate education or discrimination."

The poor who are the subject of attention here would include: 1) Those uninsured or insured with incomes below one hundred fifty percent (150%) of the poverty level [such that unpaid bills for such persons or family would be characterized as charity because of lack of insurance, or due to copayment requirements or deductibles]; and 2) those whose unpaid medical bills would exceed a standard percentage of family income [for example, ten percent (10%)] even if income exceeded one-hundred fifty percent (150%) of the poverty level.(3)RECOMMENDATIONS

The business sector and government must collaborate with the Church and health care facilities to better serve the health care needs of the poor, recognizing that the health of all is a responsibility of society in general. However, the focus of the Task Force is directed principally to the involvement of the Church.

The Task Force recommends that the medically poor, including the uninsured, the underinsured, and those with catastrophic illness or injury generating expenses beyond their ability to pay, or in some cases those who have paid and are now medically indigent, be supported at all levels of the Church community as suggested: (4)National

That a recommendation be made by the Pennsylvania Bishops to the National Conference of Catholic Bishops that the Conference update its 1981 pastoral letter, Health & Health Care: A Pastoral Letter of the American Catholic Bishops. This update would serve to address more completely the health needs of the poor and reflect the new economic realities facing Catholic health care today. Those economic realities have been especially affected by federal deficit budget circumstances which restrict the availability of health care funds. Such an updated pastoral letter should be given the broadest possible exposure and endorsement in the media and throughout the Church.That Catholic Charities U.S.A. include programs designed to increase access to health care services of the poor as one of its primary objectives.That the National Catholic Education Association stress in its publications and activities the right of all to adequate health care, and that all faith communities are called to become aware of, and involved in attending to the health needs of the poor.That the Federal government be urged by The Catholic Health Association and the United States Catholic Conference to pursue a national health policy aggressively and continue, as a priority, its efforts to provide health care and medical treatment to the nation's poorStatewideThat the Pennsylvania Catholic Conference and the Pennsylvania Conference of Catholic Health Care Facilities aggressively continue involvement in promoting and supporting legislation that furthers action: 1) to expand Medicaid eligibility and benefits to the maximum allowable amount; 2) to mandate adequate health insurance coverage for the employed, uninsured and underinsured; and 3) to provide catastrophic insurance and insurance for all individuals regardless of their state of health or preexisting medical condition.That the Pennsylvania Catholic Conference and the Pennsylvania Conference of Catholic Health Care Facilities urge the Commonwealth of Pennsylvania to fulfill its responsibility to provide reasonable payment for health care and medical treatment and to simplify the process for determining Medicaid eligibility.Catholic Health Care FacilitiesThat Catholic health care facilities incorporate service to the poor in their planning and budgeting process to include targeting a minimum percentage of total net operating revenues for service and medical care of the poor and for unsponsored charity costs.(5)That Catholic health care facilities identify health care needs of the poor in their service areas or populations, especially the following vulnerable areas or needs which require special attention:rural areaselderlyhigh poverty/unemployment areasinadequate physician coveragephysicians who do not accept medical assistanceThat Catholic health care facilities serve those groups whose access to care is limited, for example, women of child bearing age, the mentally ill and the homeless.That Catholic health care facilities incorporate commitment to the poor into orientation and education programs for board members, management staff, physicians, employees, and the local community.That Catholic health care facilities identify sources of supplies and volunteer services to assist in meeting the health needs of the poor.Physician and CommunityThe Task Force recommends that professional organizations representing physicians on the national, state and local levels suggest a minimum number of volunteer hours per month to be dedicated to providing health care and medical treatment to the medically indigent.DioceseThat each diocese integrates the health care ministry into its pastoral planning process.That each diocese within its boundaries, together with Catholic health care facilities and human service agencies, gathers information concerning health care needs of the poor and identifies available sources of assistance for parishes on health related programs.That each diocese shares with Catholic health care facilities information about specific health care needs in areas served by these facilities. That the diocesan Bishop, in collaboration with representatives of Catholic health care facilities and diocesan social service agencies:implements, as appropriate, those points set forth for diocesan activity by the Catholic Health Association in its document, No Room In the Marketplace, The Health Care of the Poor(6);publicizes through diocesan media the problems of access to health care for the poor; andserves as a catalyst in creating public insistence that all health care providers share equitably in providing care for the poor.That the diocesan Bishop, in his interaction with other faith communities, encourages their cooperation in addressing the critical health care needs of the poor.ParishThat parishes encourage greater participation by their member health care professionals in care of the poor by voluntary service.That parishes develop programs to identify the health needs of the poor in the parish and surrounding community in cooperation with the local Catholic health care facility.That parishes develop the parish social ministry in order to reach those with health care and medical needs.That parishes transmit information to the Diocesan level on identified health needs.CONCLUSION

Throughout her history, the Catholic Church has reflected the special concern of Jesus for the poor. Care of the poor is central to the mission of the Church and essential to the identity of Catholic health care. Today's societal and political conditions are threatening health care for the materially poor and marginalized.

Jesus came to teach, to preach, and to heal. In carrying out the healing ministry of Jesus, the Church in Pennsylvania is being called to reflect upon its responsibility to the health care needs of the poor among us. May we make Jesus' healing and compassion present today through our efforts and actions as a Church.ENDNOTESThe PCC Task Force on Health Care of the Poor was fortunate to have at its disposal for review and consultation, excellent source documents which were utilized if not specifically, then generally, to frame its Report. Those source documents are:

No Room in the Marketplace, The Health Care of the Poor, The Catholic Health Association of the United States, St. Louis, MO (1986);

"Unsponsored Charity Costs: A Proposed Definition for Hospital Care to the Medically Indigent," Lewin and Associates, Incorporated (as prepared for The Pennsylvania Health Care Cost Containment Council), (January 27, 1988);

"Health Care for the Medically Indigent of Pennsylvania - Three Alternative Approaches," Lewin and Associates, Incorporated (prepared for The Pennsylvania Health Care Cost Containment Council), (January 26, 1988);

"Report of the Task Force on Care for the Poor - Recommendations," Franciscan Health System, Chadds Ford, PA (1987).No Room in the Marketplace, The Health Care of the Poor, The Catholic Health Association of the United States, St. Louis, MO (1986), p. 1 "Unsponsored Charity Costs: A Proposed Definition for Hospital Care to the Medically Indigent," Lewin and Associates, Incorporated (as prepared for The Pennsylvania Health Care Cost Containment Council), January 27, 1988, p. 1 0.In significant part, the suggested actions/responses by the various entities or parts cited are the same as those recommended in the document, No Room in the Marketplace, The Health Care of the Poor, supra.Health care facilities and the Church are, in this report, called to provide health care and medical treatment of the poor. The report defines who the "poor" are but the question remains about how providing such care is to be measured. Accordingly, the Task Force recommends that service to the poor in health care facilities be measured by utilizing a tool, developed by Lewin and Associates and prepared for The Pennsylvania Health Care Cost Containment Council, denominated as Unsponsored Charity Costs (UCC). The measure then would be by determining those costs incurred on behalf of patients who cannot afford to pay, and that are recoverable only by obtaining cross-subsidies from paying patients' or non-patients' revenues or by reducing net income.

The intent of the device is:

a) to include unreimbursed costs incurred primarily for charitable purposes, including costs incurred on behalf of patients unable to pay the bills because they are poor and have inadequate insurance or because they have incurred large medical expenses in relation to their financial means; and

b) to include those costs for which there is no specific source of reimbursement whether in the form of third-party payments or earmarked government or private philanthropic grants; and

c) to include those costs based on true charity and not just bad debt (noting, however that the criteria used in the definition of "the poor" above must be applied to evaluate "charity").

In measuring what is an unsponsored charity cost, a type of care to be so included is that level of Medical Assistance outpatient payment which is unreimbursed, because reimbursement for such care is at a level well below the cost of the service provided. Additionally, the concept should include unpaid bills for the low income insured as well as uninsured.No Room in the Marketplace, The Health Care of the Poor, supra, p. 30. TASK FORCE MEMBERS

The Pennsylvania Catholic Conference Expresses Its Gratitude To the Members of the Task Force On Health Care of the Poor:The Rev. Msgr. Lawrence E. Brandt (Chairman)

Vice-President, Administrative Board
Pennsylvania Catholic Conference
Diocese of ErieThe Rev. Msgr. Joseph E. Kurtz

Executive Director of Catholic Social Services
Diocese of Allentown
(Social Welfare Department Representative)The Rev. Msgr. Edward P. Cullen

Executive Director of Catholic Social Services
Archdiocese of Philadelphia
(Social Welfare Department Representative)The Rev. George Newmeyer

Director, Office for Justice and Peace
Diocese of Pittsburgh
(Department on Justice and Rights Representative)Deacon Edward Purnell

Director of Government Programs
Office of Education
Archdiocese of Philadelphia
(Parish Representative)Sister Rose Cecilia Case, O.S.F.

Vice-President, Mission/Ministry
Neumann College
Archdiocese of Philadelphia
(Health Care System & Religious Congregation Representative)Mr. Edmund Plummer

President
St. Mary Hospital, Philadelphia
Archdiocese of Philadelphia
(Hospital CEO Representative)Mr. Thomas Gibble

Vice-President
Neumann Services, Inc., Lancaster
Diocese of Harrisburg
(PCCHCF Executive Committee Representative)Mr. Theodore Baranik

Administrator
Mercy Hospital of Johnstown
Diocese of Altoona-Johnstown (Hospital CEO Representative)Mr. George McLaughlin

Director of Fiscal Affairs
Sacred Heart Hospital, Chester
Archdiocese of Philadelphia
(Hospital CEO Representative)Sister Maria Goretti Zamberlan, R.S.M.

Administrator
St. Joseph Nursing and Health Care Center, Pittsburgh
Diocese of Pittsburgh
(Long Term Care CEO Representative)Mr. Randy Auchenbach

Fred S. James, Inc., Harrisburg
Diocese of Harrisburg
(Health Care Insurance Representative)John Cossa, M.D.

St. Agnes Medical Center, Philadelphia
Archdiocese of Philadelphia
(Physician Representative)Richard E. Connell, Esq.

Ball, Skelly, Murren & Connell, Harrisburg
(Legal Counsel)Pennsylvania Catholic Conference Staff ParticipantsMr. Michael Fastiggi; Director, Social Welfare DepartmentSister Clare Christi Schiefer, O.S.F.; Director, Health CareMr. Francis Viglietta; Director, Department on Justice and RightsMr. Bernard Shire; Director of CommunicationsMr. Howard Fetterhoff; Executive Director

Used with permission of the Pennsylvania Catholic Conference