[Congressional Record Volume 141, Number 77 (Wednesday, May 10, 1995)]
[Senate]
[Pages S6457-S6458]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


                          NONPROFIT HOSPITALS

  Mr. SPECTER. Mr. President, many may believe that health care reform 
is not an issue in the 104th Congress. But I have been advocating 
reform in one form or another throughout my now 15 years in the Senate, 
and I continue to do so. I have come to the floor on 14 occasions over 
just the last 3 years to urge the Senate to address health care reform. 
On the first day the Congress was in session in 1993 and again on the 
first day in 1995, I introduced comprehensive health care legislation. 
The Health Care Assurance Act of 1995, S. 18, which I introduced on 
January 4 of this year, is comprised of reform initiatives that our 
health care system needs and can adopt immediately. They are reforms 
which can both improve access and affordability of coverage and health 
care delivery and implement systemic changes to bring down the 
escalating cost of care. Today, I again address my colleagues on the 
issue of health care access. I want to bring to the Senate's attention 
a particular component of our health care delivery system which is 
uniquely poised to provide innovative services which respond to the 
particular needs of individual communities, but which is in jeopardy--
nonprofit hospitals.
  In my view it is indispensable that there be comprehensive 
affordable, accessible health care for all Americans. I believe the 
essential question is whether we have sufficient resources, that is 
medical personnel and hospital, laboratory, diagnostic and 
pharmaceutical facilities to deliver services. I think we do; and 
nonprofit hospitals are an important resource of innovative, community-
based care. Well over 80 percent of the hospitals in this country have 
been and are nonprofit institutions. Most nonprofits were founded 
decades ago and arose from religiously or ethnically identified groups 
and so were dedicated to serving a particular community. Most have 
adhered to this dedication to community and all of them serve without 
restriction or preference. There are approximately 80,000 voluntary 
trustees, leaders in their respective communities giving freely of 
their time, their energies, and their money to raise the level of 
health care in those communities. However, I am concerned that recent 
trends in the health care market, including the growth of large for-
profit hospital systems, and the emphasis on costs and profits of many 
managed care organizations as they become economically dominant, 
threaten the community health focus of nonprofit hospitals.
  We stand at the threshold of dramatic breakthroughs in understanding, 
preventing, and treating a variety of diseases. Clinical application of 
the breakthroughs in research will yield wondrous results which will 
alleviate 
 [[Page S6458]] human suffering, prolong life, and produce enormous 
savings in medical costs in the United States. Nonprofit hospitals are 
essential to the application of these breakthroughs for the prevention 
and treatment of disease. The community outreach programs typical of 
nonprofit hospitals demonstrate their dedication to the needs of their 
particular communities. They are uniquely attuned to the most fiscally 
and personally debilitating diseases of a community and
 therefore provide the services for treatment and prevention most 
demanded in the community. Prevention is the most successful method of 
containing the costs associated with disease as it is the first step 
toward controlling disease. But the health care system today appears to 
be making it more difficult for the nonprofit community hospital to be 
dedicated to prevention and accessible treatment for the survival of 
patients.

  While the demand to be competitive is increasing, hospitals' 
resources are dwindling. Changes in the health care system have reduced 
hospital occupancy, and have therefore reduced revenue. The Washington 
Post reported on March 14, 1995, that hospitals have quadrupled the 
number of out-patient surgical procedures and same-day procedures now 
exceed the number requiring overnight stays. Health care experts cite 
technological advances as well as cost-cutting efforts by insurance 
companies as two key factors which have encouraged the growth in 
outpatient services. For-profit hospitals tend to exclude those from 
coverage and service who cannot afford to pay and minimize nonrevenue 
generating outreach programs.
  On the other hand, nonprofits are committed to their missions to 
provide high-quality service, thus increasing expense, but not 
necessarily increasing revenue. The limited revenues which once could 
be used for outreach and prevention are being reallocated to meet 
today's specialized care needs, and at the same time hospitals are 
being forced to compete with one another to maintain their existence.
  As we continue to discuss the reform of our health care system, we 
must reconcile the two forces which drive provision of hospital care 
today, that is profitability and quality. Hospitals should be able to 
continue to operate as a community resource, to provide preventive 
medicine, not only curative medicine. As I have said, prevention is the 
most economical cure for what ails our health care system, that is 
escalating costs for short- and long-term treatment. Prevention and 
early detection are the most successful methods of controlling costs 
associated with disease as they are the first steps toward preventing 
the inevitable need for costly treatment incurred by disease.
  In S. 18 I have taken such steps through streamlining the statutory 
provisions related to the right to decline treatment, increasing 
Federal support for clinical trials at the National Institutes of 
Health, and increasing public health programs at the State and local 
levels. I look forward to working and reconciling the competing forces 
in our health care system today to ensure the continuation of 
community-based and -focused prevention and treatment services, such as 
those historically provided by nonprofit hospitals.


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