Like the weather, everyone complains about the high cost of health care but no one does anything about it.
Well, Utah Community Health Plan (UCHP) is giving it a shot.Formed in October 1989, UCHP is a private health maintenance organization (HMO) that is offering its services exclusively to small businesses that don't provide their employees with a health plan.
The intent, said executive director William K. Willson, is to make health insurance coverage affordable to a segment of the population that doesn't have it on their jobs and couldn't afford to buy it privately.
That is not a small number. According to a 1986 Utah Department of Health survey, there were more than 227,000 uninsured individuals throughout the state, or 13.5 percent of the populace.
The premise is simple: UCHP offers coverage similar to other health plans but with premiums about 40 percent below the going rate, thus making coverage affordable to a large number of small businesses who wouldn't otherwise offer it.
That, too, is not a small number. According to Willson, some 50 percent of Utah businesses with 10 or fewer employees do not offer health plans. In Salt Lake County, there are an estimated 60,000 employees of businesses with 19 or fewer employees who do not have coverage.
How important is the workplace to health insurance? Willson says two-thirds to three-quarters of all insurance is obtained through employers. The problem, he said, is that even with premiums 40 percent below the norm, it's still a hard sell for UCHP to convince these small companies that they should offer their workers a health plan. (Employers are required to pay part of each worker's premium.)
Still, the plan has made a good start. Since it opened 17 months ago, UCHP has signed up some 1,500 "covered lives" (including dependents of in-sureds) 90 percent of whom had no previous coverage. Average income of those covered is $21,000 for a family of four - 160 percent of the federal poverty level.
UCHP is owned by Intermountain Health Care (IHC) with directors from Salt Lake Community Health Centers, Holy Cross Hospital, and University Hospital. It was formed on the heels of a study by IHC and the Robert Wood Johnson Foundation as a community-based effort to make health insurance more affordable to low-income people.
That, of course, is a good trick. It's accomplished in a variety of ways, but the prime factor is that UCHP's hospitals and physicians give 35 percent discounts to members.
Why would they do this? Because, said Willson, even the uninsured are seldom turned away by hospitals and that means they often end up writing off 50 percent of their bill anyway. With doctors, it's harder to nail down figures, but Willson said it's safe to say that "the larger the bill, the lower the collection rate."
"They go along because this is better than what they have been getting," said Willson. Also, to their credit, providers see it as "a healthy attempt to do something worthwhile."
But it's not charity, and those hefty reductions in premiums require UCHP to maintain tight control over costs. A small number of primary care providers are carefully selected by UCHP for their ability to "always think of cost considerations" when prescribing tests, treatments and medicines.
This, he said, is a tight line to walk because UCHP providers are as subject to malpractice claims as any other.
Administrative and marketing costs are also kept to a minimum. Willson said these costs typically average 25-30 percent of a health care premium, but UCHP has pared that to a lean 16 percent.
UCHP's future plans include expansion into Weber County and to make coverage available to part-time workers - without requiring an employer contribution.