Making 'transparency' more clear

John Taylor: July 16, 20070 Comments

I believe you should be able to read and understand the charges on your hospital bill.  I believe they should be easier to comprehend than a) your cell phone bill; b) your high-speed Internet and HD bill and gizmo rental; and c) just exactly when your electric/gas meter reader will come to do his work.


So, I believe it's important to understand some of the "hidden" costs that a hospital absorbs -- generally called "unfunded mandates."  They arise when state/federal regulators/lawmakers impose new requirements -- some of them clearly to the public's benefit -- but don't provide hospitals any money (or very little) to meet the new laws.


Here's what your hospital bill may not show.



  • The Emergency Medical Treatment and Active Labor Act (EMTALA; enacted by Congress in 1986). The good: It requires hospitals with emergency departments to provide access to emergency services regardless of a patient's ability to pay. The not-so-good:  Only hospitals with EDs must comply, meaning specialty/surgery clinics are spared the cost of caring for the no-pays. And, of course, costs are shifted to people who have insurance.

  • SB 1953 (hospital seismic retrofit ordered by California after 1994 Northridge quake). The good: Enhanced patient safety. The not-so-good: Cost. The California Hospital Association estimated the overall cost of retrofitting, remodeling or rebuilding at $50 billion with some hospitals closing/downsizing. Cost of adding one additional bed now hitting $2 million. Cost shifting again.

  • The Health Insurance Portability and Accountability Act (HIPAA; enacted by Congress in 1996, and which began taking affect in 2003). The good: Patient privacy protections and confidentiality of medical records. The bad: Hospitals foot the bill for new sweeping paperwork changes and staff training.

  • Nurse-to-patient staffing ratios in California, implemented in 2004. The good: More nurses at patient bedsides. The not-so-good: Shortage of nurses -- California ranks dead last among all states in numbers of nurses per capita. And no supplemental funding to hospitals for recruiting and retaining nurses. The real bad: California is projected to be short 116,000 nurses by 2020.

Nearly 6.5 million Californians, more than 20% of the state's population, are uninsured. Between 2000 and 2005, 25 hospitals closed in California with a loss of more than 3,000 beds. Nearly 30% of California's 355 general acute hospitals were in the red in 2005, according to a study by PricewaterhouseCoopers.


Clear or not, the results are in your bill.