Cost of health care can prevent some from seeking cancer treatment

By | March 12, 2009

Cancer is a social justice issue within the context of affordable health care, said Jim Coller, president and CEO of St. Mary’s and St. Vincent.

“The poorer you are, the more scary cancer is,” he said. “When a person is diagnosed, there are levels of fears. The first being, ‘Will I die?’ More people today are living with chronic diseases than in the past. Once a treatment plan is decided, another fear arises for many people. When you add ‘Who can pay the bill?’ your life can become overwhelming.”copingwithcancerlogoweb

Coller’s experience with cancer extends beyond his work as a hospital administrator. Fourteen years ago, he was diagnosed with prostate cancer, which required major surgery and 35 days of radiation treatment. Coller said his care may have been much different if he did not have good insurance and the ability to pay for health services.

“Two years later, the cancer returned,” he said. “I receive an analyzed amount of chemotherapy each year for the past 12 years now. If I had to pay the entire amount of the chemotherapy, it would cost approximately $10,000 a year. I take medications that would cost me $800 a month if I didn’t have insurance. I’ve been blessed. So many people are not as fortunate.”

The mission of the Hospital Sisters of St. Francis guides the ministry of St. Mary’s and St. Vincent, and their sister hospital, St. Nicholas in Sheboygan. The medical facilities serve all patients no matter their ability to pay.

“Our emergency rooms are open and we have good strong programs,” said Coller. “The ER is where the poor people go in any city when other means of getting access to care is closed.”

Appleton reports that one out of every five ER patients is not insured. The commitment to keep the emergency rooms open continues, but it places a burden on Catholic hospitals, he said.

Many patients use aliases or provide false information when seeking care through the ER because of their inability to pay.

“You would not believe the amount of mail that is returned to us because the person does not exist at the given address,” said Appleton. “We are always working to make sure we keep our good paying patients so we can serve those people who cannot afford health care.

“People shouldn’t be afraid to come in for care,” he added. “We have a charity care policy where the percentage of benefits is determined by the person’s income and number of dependents. If they come in, we are going to work with them the best we can with the resources that are out there.”

St. Mary’s and St. Vincent provided more than $24 million in benefits to the poor in 2008.

Even if a patient has insurance, cancer can create a financial burden. Appleton points to the change in deductibles for many patients as an example.

“I’ve been doing this for 37 years,” he said. “Deductibles used to be $250 to $500. Now deductibles for many people are $2,000, $2,500 or $3,000. That’s a lot of money to pay out of pocket. When it was $250, it was easy to make five payments of $50 each. Now it’s five payments of $500 each.”

Sally Luehring, cancer service line administrator for St. Mary’s and St. Vincent, said aftercare suffers for patients struggling financially.

“It could be a situation where a person has too much debt from the initial treatment that they delay or don’t follow through with community care,” she said. “The possible recurrence can be more advanced when they do return.”

Preventative care also suffers for patients with a financial burden, added Luehring.

“People are more reluctant to have screenings when they have to pay out of pocket,” she said. “A person may put off having a colonoscopy, for example, because of the cost.”

St. Mary’s and St. Vincent is developing its Regional Cancer Collaborative to make cancer care more convenient for patients in surrounding areas. The partnership includes Bay Area Medical Center, Marinette; Door County Memorial Hospital, Sturgeon Bay; Holy Family Memorial, Manitowoc; Community Memorial Hospital, Oconto Falls and St. Nicholas.

The collaborative is a joint venture with Green Bay Oncology.

Patients who previously had to travel to Green Bay for treatment now can receive care at their community medical facility.

“What many people don’t realize is our doctors are willing to get in their cars and drive to serve the people in the outlying areas,” said Coller.

St. Vincent is one of two medical facilities in Wisconsin and 62 in the country funded by the National Cancer Institute to conduct clinical trials.

“The good thing is we are blind to economics of the people on trials,” said Appleton. “They volunteer and there is no economic decision involved.”

St. Vincent currently has 331 patients on study for clinical trials and 678 who have finished their treatments. Clinical trials allow for experimental procedures and drugs.

“Trials become a bank of knowledge,” said Luehring. “It is truly how we improve cancer care. Over time, it’s how we develop better treatments.”

The good news about cancer is more people are getting tested at an early age, getting treatment and surviving the chronic illness with a good quality of life, said Coller. But the struggling economy heightens concerns.

“The economy has a direct effect on health care,” he said. “Your financial situation affects your diet. Are you getting enough rest? If you have stress caused by your finances, it can affect your rest. It’s a struggle, but people should not avoid necessary care. The Catholic hospitals have and continue to serve as a security net for indigent people.”

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