DOCTORS LEARN OF ALLIANCE; BUSINESSES TELL OF HEALTH CARE IDEA

A group of businesses that want to form a health care alliance in an effort to reduce health insurance costs pitched the idea Tuesday to local physicians, who said they too are fed up with high health care costs but are not to blame.

Twenty-nine local businesses are involved in the group, called the Southeast Missouri Business Group on Health. An alliance among the businesses would mean they would all carry employee health insurance through the same company. The result would be lower insurance costs for business owners and employees.

Greg Kuhn told physicians at a meeting Tuesday night that the group could pinpoint what medical procedures are most often performed and the cost of those procedures. Kuhn represents the William M. Mercer consulting firm of St. Louis, which was hired by the business group.

He said on a national level about 30 percent of all medical procedures are unnecessary, and eliminating those procedures would hold down overall medical costs. He also said that overall the current system of health care "hasn't worked."

"I think we need to make a basic change in the way we look at health care," he said.

But local physicians disagreed with Kuhn's figures, saying 30 percent of medical procedures performed locally are not "unnecessary."

They said the problem of skyrocketing health care costs can be blamed on increased overhead to physicians, the threat of malpractice and the high number of patients on Medicare.

Dr. Jesse Ramsey, a pediatrician, said the system suffers because the heaviest users of health care are Medicare recipients.

"It's a something-for-nothing society," Ramsey said. "The people who pay nothing are the ones who use it the most.

"Right now 68 percent of people having babies in Southeast Missouri qualify for Medicare," he said. Ramsey said new Medicare guidelines mean that number could jump to 85 percent. Doctors are typically reimbursed for only a fraction of the actual costs for treating Medicare patients.

The costs for non-paying patients are ultimately passed on to the physician and other patients.

"We've got to get some common sense somewhere," Ramsey said.

Business owner Tim Schwent said businesses and physicians must work together to "get a handle" on the problem of high health care costs.

"The people who don't pay for the care are getting all the care, and I'm paying for it, you're paying for it, and our taxes are paying for it," he said.

Nurse Brenda Burk said the current system makes preventive care costly and patients typically wait until they have a major health problem to seek medical help.

"Patient education, employee education is poor," she said. "Most of these problems could be detected during a yearly physical, but people don't seek out yearly physicals because they have a $250 deductible for physicals."

Kuhn said that unless something is done to curb health care costs, "by the year 2000 the federal government will have control of all health care.

"The initiative has to be taken on a local level," he said.

Mike Dougherty of Southeast Missouri State University said business owners have had to shift health insurance costs to their employees, resulting in higher deductibles and higher rates. He suggested businesses and physicians work together to try and keep costs down, and he said a health care alliance might be one way to do that.

"If we don't work collectively to see what we can do, the business community will have to continue to find ways to address cost issues," he said.

Physicians were also concerned about which health insurance company would be the primary vendor for the group and whether patients would be referred to other cities for health care.

Jim Wente, administrator of Southeast Missouri Hospital, said it will take a high level of confidence between business owners and physicians for the alliance to work.

"I think there is a process of trust that has to be accomplished," he said.