What is driving the rising cost of health care, particularly in Washington State? There are a number of things, according to several people in one aspect of the business or another.

Harrison Hospital’s Kathy Sanford, vice president of nursing services, says the big-ticket items include technology, medications, medical personnel shortages (therefore higher salaries and financial enticements), the growing number of people without medical insurance, malpractice insurance and an aging population, for starters.

Technology, Sanford elaborates, “is ever-increasing, expensive and expected.”

Patients demand and deserve the best in diagnostic and treatment options, adds Patti Hart, media relations coordinator for Harrison.

Most pharmaceuticals get high praise from Hart as “a really good thing, bringing back quality of life, or even saving of life.”

Drug companies are no longer marketing just to medical professionals, but are taking their message directly to the public. Sanford explains that the cost to drug companies of research and marketing must eventually be recouped in sales.

Part of the hospital’s cost of doing business includes various types of insurance, including liability (up $1 million in the past year, according to Hart), insuring the facility and its contents, and health insurance for employees.

Ultimately, the hospital’s paying users must cover the costs of doing business. Harrison’s emergency room is undergoing a $13 million renovation now, too.

Malpractice insurance has become a necessity for physicians. Those in the high-risk categories (OB/GYN, orthopedic surgery, trauma, neurosurgery, etc.), pay much higher premiums than a family doctor who does no baby deliveries or surgeries. The family doc paid, on average, $9,779 in 2001, whereas the OB/GYN was paying $51,878 annually, according to a paper published by the Washington State Medical-Education and Research Foundation.

Some physicians, concerned for future lawsuits, have resorted to a sort of defensive medicine, ordering costly tests, just to cover themselves. That same concern is one reason more babies are being delivered by C-section, necessitating increased capacity in hospitals.

“We are a litigious society,” adds Hart, stating the obvious.

Our state legislature, echoing partisan battles at the national level, has split over how to address these problems. During the 2003 regular session, the State Senate, with Republicans in the majority, passed legislation (SB 5209, 5728) that included setting caps on the pain and suffering (non-economic) awards to patients who have been victims of medical errors, as well as limiting attorneys’ contingency fees, and more.

Meanwhile the State House, with Democrats in the majority, passed legislation (HB 1642, 1865, 1926, 1927, 1928, 1929) to improve oversight of those physicians deemed repeat offenders, mandate out-of-court mediation, enhance patient safety by working to reduce medical errors, among other aims. At press time, neither house had voted on the others’ bills.

According to the Washington State Medical Association (WSMA), our state is losing doctors to earlier retirement and to other states. In Skagit County, WSMA reports, the number of obstetricians practicing was halved this year, placing the blame on dramatically increased malpractice insurance premiums for 2003.

Stephanie Marquis of the Office of the Insurance Commissioner for our state, says in the current, cyclical “hard market,” insurers have lost “significant investment money.” Therefore, they have “become more picky” about whom to insure and what risks to cover.

Since the higher cost of various types of insurance is part of what hospitals and doctors must pay, and then must charge more to cover expenses, the whole health care cost issue becomes “a spider’s web,” Marquis describes.

She indicates that “all the big players are here” in the state, and names Premera, Regence, Group Health and KPS Health Plans as the largest insurers in Washington.

David Peel, vice president of finance for KPS Health Plans, says that several companies consolidated a few years ago, partly driven by capital, partly by our mobile society, with more employers having employees not restricted to a single county, for example.

Peel says that state law requires a large amount of untouched reserves for an insurance company to remain in business in Washington, which OIC’s Marquis explains is essential to be able to cover claims.

The number of uninsured in our state was at 11.5 percent in 2002, and climbing, with the legislature cutting access to Basic Health and Medicaid.

The uninsured often let health concerns go to a crisis point, then seek treatment in the hospital’s ER, the most expensive way of meeting needs. Those who do pay, both patients and insurance companies, ultimately cover these expenses.

In a paper trail of work done, caregivers keep significant records of treatment, showing it is legitimate and approved for reimbursement. Therefore, bureaucracy adds to the high cost of health care.

When the federal government’s Medicare or Medicaid programs cover care, the paperwork is increased, while physicians complain that reimbursements do not even meet expenses. Therefore, more and more doctors are limiting or excluding such patients from their practices.

The Doctors Clinic, with offices throughout Kitsap County, as of June no longer offers mammograms. Patients, while being referred to Advanced Medical Imaging, located in the Silverdale Harrison Hospital, have been told that the expense of updating/replacing equipment caused them to rethink doing this diagnostic procedure. All personnel will be retained in x-ray and similar positions, according to one employee.

Solutions to runaway health care costs suggested by Cassie Sauer, spokesperson for the Washington State Hospital Association, include more people having access to insurance, medical malpractice reform and administrative simplification.

Dr. Scott Lindquist, director of the Kitsap County Health District, says he would love to blame the high cost of health care on one group, “but I can’t do it.”

Lindquist speaks passionately of prevention as the most important long-term strategy. Tying up the community’s resources for the choices of our personal habits – such as smoking, dietary indiscretion, lack of physical exercise – means when we go to look for the blame, a lot of it will end with ourselves.