ROBERT BILBRO: Change to 'Certificate of Need' shouldn't ignore those most in need of care

Recently ECU Health announced that it was closing five regional clinics serving women and families in largely rural areas in the eastern part of the state after facing a loss of $46 million last year.

There is a reason why the state’s certificate of need program functions to assure a certain economic return for health care providers -- so everyone, regardless of where they live or what their economic status, will have access to the medical services they need.

It is not a far-fetched notion that without regulations like certificate of need, medical entrepreneurs would establish services and clinics in the areas of greatest potential profit. As a result, rural or impoverished areas and those without the means to pay for services, would likely be left with even fewer possibilities to find the care they need.

Linking the much-needed and too-long delayed expansion of Medicaid to alterations in the state’s certificate of need regulation isn’t about healthcare but about politics. The two issues should be dealt with separately. There is no excuse for any further delay in providing care to the more than half-million North Carolinians who have lacked access for decades – especially with a viable solution available over the last 14 years.

Public policy in North Carolina should protect hospitals from medical facilities that erode their ability to balance their budgets and in some cases will drive them out of business.

Some aspects of providing services in hospitals, such as behavioral health, obstetrics and general medical care are not profit centers and, in fact, typically generate a deficit. Hospitals depend on procedures -- medical and surgical -- to generate the revenue necessary to balance their budgets and keep them operating.

Policymakers should recognize that hospitals are required -- legally and ethically -- to accept all patients who come to them even though the patient may be uninsured or covered by Medicaid (which pays less than commercial insurance plans).

Healthcare providers have valid concerns that if certificate of need regulations are eliminated, profit-seeking enterprises will set up medical facilities offering just procedures that are the most economically favorable. Hospitals would be left as the provider of last resort to offer the services the profit-seeking enterprises neglect.

Any proposals to change or even eliminate certificate of need, should include the requirement that ALL healthcare facilities must serve a defined portion of uninsured and those on Medicaid. While helping assure all those who need care get service, it would also help to mitigate the negative impact on the finances of nonprofit hospitals.

Requiring ALL medical providers to serve a portion of uninsured and Medicaid patients will work toward assuring healthcare services are accessible to ALL those in need, regardless of where they live, their economic status or the kind of health care coverage they use.