News Column

Health Report: Inside the Care Crisis

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It’s not news that the healthcare situation in the United States has become a huge, seemingly hopeless headache. But Ruben Medina goes so far as to call it a war.

“The healthcare war has four players in it, whose interests aren’t always the same: insurance, hospitals, community providers, and the patient population,” explains Mr. Medina, CEO of Promesa, a New York–based health and human services organization that aids the underserved. In the battle between insurance companies and hospitals, minorities have been caught in the crossfire, he says.

Recent studies confirm Mr. Medina’s assessment. The National Coalition on Health Care predicts that health insurance premiums will increase 20 percent or more for many small businesses in 2002, forcing some to drop coverage altogether. Hispanics own about 1.5 million business in the United States, and most of those fall into the categories most vulnerable to healthcare cost increases – sole proprietorships and firms that employ fewer than five people (see “‘Perfect Storm’ Strikes CEOs,” April 2002).

But the storm will affect more than Hispanic CEOs. A report released in March by the Institute of Medicine, an independent research group that counsels Congress, suggests that minorities receive inferior health care compared to Anglos, even when their insurance coverage and incomes are comparable. Below the coverage line, the uninsured segment of the healthcare market consists predominantly of low-income working families. Eight in ten of the uninsured come from working families but do not obtain coverage in the workplace, according to a Kaiser Family Foundation report.

Without a comprehensive governmental solution to the healthcare crisis, Hispanic hospital administrators have put guerrilla strategies in place to soften its effects and provide basic care. They’re conducting community outreach programs and attempting to engage people in wellness practices rather than treating them only when they get sick. They’re educating CEOs and corporate managers on health insurance alternatives. They’re streamlining their own operations to keep costs low. And they’re recruiting culturally astute colleagues and making sure opportunities exist for Hispanics seeking careers in the health industries.

George Zeppenfeldt-Cestero, president of the Association of Hispanic Healthcare Executives (AHHE), believes a major reason for high healthcare costs is that those who lack both insurance and information on available health resources tend to avoid treatment until health crises demand emergency room treatment. “There are lots of Latinos at a lower level economically who can’t afford health insurance. When their children get sick, they’re going to go to an emergency room because the children don’t have physicians they see on a regular basis,” Mr. Zeppenfeldt-Cestero contends. “That’s one of the contributors to the huge increases in healthcare costs. In this society, we haven’t put much value on the issue of prevention, but we have to make sure that consumers are educated.”

CEOs hold high priority in the AHHE’s education campaign. “The hospital does a lot of work with the chamber of commerce to educate CEOs and business men and women as well as the neighborhood at large,” says Jeannette Marrero, an AHHE member who serves as interim executive director at the University Hospital of Brooklyn. “We talk about healthcare and how they can best access it.”

How can executives fight the healthcare crisis? Industry officials insist that healthcare costs would drop if individuals were encouraged to engage in health-promotion and disease-prevention practices, such as controlling their blood pressure, quitting smoking, losing weight, and exercising. The workplace can play an important role in employees’ adoption of such activities.

Employers should learn what health insurance options are available for their employees and their families. To lower direct costs, they could help employees navigate private and government programs. Several federally funded programs, for example, offer healthcare access for children who don’t qualify for Medicaid.

Managers should also become involved with professional organizations and advocacy groups engaged in the health policy debate, which is expected to heat up during the next several years. “The best strategy employers can take to control healthcare costs is to be active stakeholders in the health policy dialogue,” says Mr. Zeppenfeldt-Cestero. “That means increased involvement in community health initiatives and being a leader in partnering with local healthcare providers.”

While encouraging CEOs, AHHE also works with administrators to develop models for delivering healthcare to Hispanic consumers. At University Hospital of Brooklyn, Ms. Marrero has established satellite and outpatient facilities. “Instead of having patients come to us, we go to them,” she says, adding that all hospital employees work hard to make sure costs are kept down by eliminating unnecessary testing and reducing the length of patients’ hospital stays when possible.

Promesa’s Mr. Medina, also an AHHE member, runs a similarly tight ship. “We’re pretty religious about monitoring our quality of care as well as our level of expenditures, and equating one with the other,” he says.

The campaign borrows techniques from small-business marketers and applies them to healthcare delivery. Promesa employees hit the streets to let people know about services and providers. Vans circulate through the local communities, testing children for asthma and lead poisoning. Promesa also takes the unique position of working directly with drug users on the streets rather than waiting for them to seek treatment by coming to a facility. “We pretty much serve all the taxicab companies, bodegas, and employees in our local area. Healthcare is like real estate, but instead of location, location, location, we are local, local, local,” Mr. Medina says. “We are aggressive in explaining to them the funding sources available. We’re trying to develop the sense that people, irrespective of how they come to us or how we come to them, are not stupid. They’re inherently intelligent, and the more information we can give them, the better off they are.”

But AHHE’s local success doesn’t necessarily mean other providers are eyeing the Hispanic segment. “It’s hard for the average healthcare provider to know how to reach our market,” says Mr. Zeppenfeldt-Cestero. For example, Mr. Medina points out that Promesa enjoys a good rapport in the Hispanic community because so many of the organization’s employees speak Spanish. At most healthcare facilities, language remains a major barrier to access. “We must seek out administrators who know how to reach [the market],” says Mr. Zeppenfeldt-Cestero. “That has always been one of the major roles of AHHE.”

Bringing diversity to health administration means getting Hispanics in the pipeline for executive positions in the industry. According to the Washington, D.C.–based National Hispanic Medical Association (NHMA), only 813,770, or 5 percent, of the nation’s doctors are Hispanic, while Hispanics account for more than 12 percent of the U.S. population.

“Many of these [Hispanic] physicians are retiring and won’t be replaced fast enough to keep up with demand,” says Dr. Elena Rios, NHMA president. “We must recruit more Hispanics into medicine, or the well-being of our communities and the nation will suffer.”

AHHE has the mission of fostering more Hispanic senior managers in the healthcare, hospital, and pharmaceutical industries.
(For information on intern and enrichment programs, visit the Web site at The organization took on the challenge because of the unique cultural issues inherent in care delivery, Mr. Zeppenfeldt-Cestero explains. Hispanics are more prone to diabetes, asthma, and high blood pressure than the national average, he says, and they need education on managing both the costs and the risks posed by these diseases. That education should come from someone who understands the social context as well as the science of healthcare for Hispanics.

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