Voters responding to the Utah Foundation's 2008 priority survey ranked health care as the fourth most important issue facing the state.
In October, the independent public policy organization released a research report evaluating the key issues necessary for health system reform to occur in Utah.
In order to identify the issues, researchers interviewed representatives from six different stakeholder groups of the health system industry. The groups included the government, insurers, hospitals, providers, businesses and consumers.
During the interviews, common themes emerged. Based on the themes, the foundation identified several crucial issues
Escalating health care costs create a negative feedback cycle within the market, making insurance unaffordable for people, indicated the report.
Rising numbers of uninsured Utahns are forced to rely on public programs or receive uncompensated care. It is estimated that up to 12 percent of the money spent on uncompensated care is cost-shifted onto private health insurance premiums.
During the current decade, the percentage of Utahns utilizing government-based insurance has increased as the number of state residents with private coverage has declined.
The Utah Department of Health estimates 287,200 uninsured people resided at locations statewide in 2007.
The number equals 10.6 percent of the state's overall population and represents a 1.3 percentage point decrease compared with 2006's uninsured rate.
Between 2001 and 2007, the number of uninsured Utahns expanded at an average annual rate of 6.3 percent, compared with the state's 2.7 percent overall population growth level.
From 2003 to 2007, the average health insurance premium for a family of four increased by 18.5 percent. Employer contributions fell to 72.9 percent from 75.1 percent of the total premium.
The percent of Utah firms with 100 workers or less offering health insurance has decreased since 2004, implying the employees are purchasing personal insurance, going without coverage or receiving public or private assistance.
Along with the steadily mounting number of uninsured Utahns, factors contributing to rising health care costs include :
â¢Increased hospital, physician and clinical expenses due to delivering more technologically advanced care.
â¢Increased hospital charges due to provider consolidation and less competition.
â¢Significant growth in prescription drug expenditures.
â¢Persistent overuse, misuse and waste of health care.
The United States government has enacted federal legislation limiting local health care reform efforts, pointed out the independent public policy organization.
For example, the Employee Retirement Income Security Act poses a major obstacle to Utah's reform efforts.
The federal legislation removed competing state laws on insurers and employees focusing on benefit plan administration.
States frequently encounter challenges with ERISA's pre-emptive clause. The guideline specifies that the federal act supersedes all state laws related to employee benefit plans.
"The current structure of the U.S. health care system is like a giant puzzle. Creating a new picture out of these pieces means that some will be included and some will not, while other pieces will need to be re-cut to fit into the new picture. Because some pieces are left out, not everyone will be satisfied. As this process continues, it will become clearer what the new picture should look like," noted foundation research analyst Laura Summers
But despite federal regulations hampering health system reform, states can address multiple areas.
The areas include insuring the unemployed, providing reliable access to information on costs and working to make coverage affordable to individuals.
Systemic reform calls for the participation of insurers, providers, hospitals, consumers, employers and the government.
"It is clear from this report that health care reform is no simple matter. But the legislative task force has assembled a strong group of stakeholders who are taking the matter seriously and working hard to answer the right questions. If reform is possible anywhere, it should be possible here," noted foundation president Stephen Kroes.
An overarching goal of state health system reform involves addressing three pillars of the process: cost, quality and access.
While proponents maintain that some strategies to improve quality and expand access will decrease costs by improving efficiency, many stakeholders acknowledge that there are potential trade-offs among the three pillars.
One potential trade-off mentioned by hospital and insurance representatives involved how to encourage medical innovation while keeping down costs, indicated the foundation's research report.