When the Group of Eight industrialized countries meets next week in Japan for its annual forum, the economy, which has even forced people living in the richest countries to penny pinch, will likely be at the center of discussion.

While residents in the Upstate are thinking about money wherever they go, from gas stations, to shopping malls, to grocery stores, perhaps nowhere does the weight of global economics hit harder nowadays than at hospitals or doctor's offices.

'Bad week'

"It's been a bad week," said Jane Hardy, who works in billing and insurance at Oconee OB-Gyn Associates, on the vast influx of patients met with shock this week upon realizing their Medicaid coverage was automatically switched to a health maintenance organization (HMO), or managed care, program. While the Oconee office is signed up with some managed care programs, it's not enrolled in all.

This has left many patients with two options. Visit an office that is enrolled in an accepted plan, and in some cases, this has meant traveling 100s of miles. Or go to the hospital, where pregnant patients can't be turned away.

Hardy said the insurance problem likely arose because, even though Medicaid beneficiaries received a mailing requesting the patient pick their preferred plan, the correspondence was likely either overlooked or unknowingly thrown away.

"One (patient) actually delivered a baby in this time frame to where she was under another plan," Hardy said.

She said an official who works with Medicaid and managed care programs has "agreed to cover these patients when they are in situations that would be a risk to their health. Now, we haven't seen that yet because this has just happened."

As a result, the OB-Gyn office, which claims to be the only office of its kind in the area to treat patients covered under Medicaid, has been put in a tight spot.

"It's putting the physician in a bad situation as well as the patients," Hardy said. "We're scrambling to get these people taken care of."

Nationally, HMO coverage has shown a steady rise in the last decade. According to a report from the Centers for Medicare and Medicaid Services (CMS), a little more than 65 percent of Medicaid recipients in the country were enrolled in managed care plans as of June 30, 2006, compared to nearly 48 percent in 1997. In South Carolina, a little more than 20 percent were enrolled in these plans in 2006. By comparison, more than 97 percent of Medicaid patients were covered my HMOs in the same year in Georgia and about 65 percent in North Carolina.

Currently, the Oconee OB-Gyn office is enrolled in these Medicaid managed care plans: Total Carolina Care Inc., First Choice by Select Health of South Carolina and South Carolina Solutions. The South Carolina Department of Health and Human Services lists five other plans currently operating in the state as of May 1.

For local expectant mothers who were automatically switched, Hardy suggested calling their case worker at the Department of Social Services and instructing Medicaid to unenroll them from the current plan and sign them onto a plan the Oconee OB-Gyn office is already enrolled under.

High expectations, yet modest means

While 690,000 people in South Carolina are covered under Medicaid, according to the CMS and another 700,000 in Medicare, which together represent about 30 percent of the state's population, 15.6 percent are void of any health insurance coverage, according to a 2005 report from the Atlanta, Ga.-based Centers for Disease and Prevention. Nationally, 42.1 million people are uninsured.

These insurance and economy trends have impacted the bottom line of budgets recently at local facilities like Oconee Medical Center, where monthly losses in 2007 required the hospital to cut positions and increase care rates.

In 2007, the hospital finished the year with about $11.8 million spent on uninsured or indigent patients, according to the Chief Financial Officer Greg Scarbrough. For 2008, he said he anticipated spending roughly $15.8 million. Through May, the number has already reached $10.5 million

Jeanne Ward, president and chief executive officer with Oconee Medical Center, in an e-mail correspondence, pointed to the economy as the "primary factor," in the rise of uninsured and indigent patients.

"In the Emergency Department, we are required to see all patients," Ward said in the e-mail. "The issue is not the law, however, we believe in caring for everyone, regardless of ability to pay. ... Each organization makes its own decision on this issue, and some do choose to turn away people who cannot pay for service. We do not have universal healthcare in the United States, but people do expect to receive care whether they have the ability to pay or not. In the absence of a national solution, our community hospitals step up to the plate every day and deliver care to everyone."

Despite May being the second month in a row the hospital was over budget in bad debts, the hospital has seen a positive revenue stream of about $300,000 over what was budgeted since the beginning of the year. The hospital also finished 2007 about $1.2 million in the black.

"It really goes into growth and outpatient volumes, trying to stay on top of it," Scarbrough said about the positive figures.

Oconee Medical, co-owner of Clemson Health Center in Clemson, as well as other clinics in the area, is also affiliated with Oconee Physician Practices, which operates five offices in the area. Its executive director, Matt Hedtke, said the health care industry in general is "in sync" with the state of the economy in general.

"But unfortunately, regardless of the economy, people continue to get sick," he said.

As reported in a previous story in the Daily Journal/Messenger, an increase in health care jobs between 2000-2006 has helped bolster the local economy, which has seen hits in other industries. As reported by the U.S. Census Bureau, the health care and social assistance category in Oconee County amounted to about 2,800 in 2006, an increase of 400 jobs since 2000. In Pickens County, 3,439 were employed in that category in 2006, compared to 2,983 in 2000.

Hedtke noted: "health care continues to thrive because it's one of those public services that needs to continue to operate."

He said the offices he oversees will take both "self-pay" patients, those with Medicaid or Medicare coverage and commercial insurance. The company is part of a program called the Best Chance Network, which provides needed cervical and breast cancer screenings for patients with no insurance or inadequate coverage. The program is for women ages 47-64 who meet certain income guidelines.

Hedtke said that Oconee Physician Practices is also attempting to obtain "Real Health Status" designation through the South Carolina Office of Rural Health, which would allow the company's offices to increase their ability to serve a larger block of the community. The status is granted based on whether a locale is underserved, as determined by a ratio between physicians and total population of an area.

"A lot of the other places in town, they do have to make that choice, to not see any more Medicaid folks or not at all because it just doesn't cover the cost" of service, he said. "... It's getting difficult."

When questioned about some national solutions, like universal health care offered in other countries, Hedtke said patients may be seen by doctors quickly under those systems, but when other tests and procedures are needed, he pointed to long waiting lists as inadequate.

"In my opinion, I think the citizens of America would not be satisfied with that," he said. "And we can't cover Medicaid and Medicare right now. Where is that expense going to fall?"

At present, with changes in Medicaid, escalating costs of commercial insurance and increasing numbers of uninsured and indigent patients, the cost of care seems to be weighing heavily on most segments of the population. And, for the Oconee OB-Gyn patient who happened to go into labor just as the Medicaid hammer fell, the doctor's office still delivered the baby, and the hospital still offered a room. In the end, humanity triumphed.

"We're looking at continuity of care here," Hardy said. "Because where is a 37-week patient going to go?"