Navigating the Rising Cost of Care
Written by Melanie Dempsey
With 54,000 skilled and dedicated professionals, West Virginia’ s hospitals stand as guardians of health care access across the state. They deliver critical care around the clock, every single day, regardless of circumstances. Hospitals are the backbone of their communities, providing essential and life-saving services residents rely on close to home. West Virginia community hospitals offer a full continuum of care, from emergency and trauma services to maternity care, diagnostics, chronic disease management and specialized treatments, ensuring patients do not have to travel long distances to receive the support they need. Hospitals also serve as centers of expertise, coordination and stability, bringing together skilled professionals, advanced technology and critical resources under one roof.
Despite the vital role they play in their communities, West Virginia hospitals face significant financial pressures, largely because their funding depends on the insurance providers of the patients they serve. In West Virginia, as the chart below shows, hospitals face added strain because fewer residents have employer-sponsored insurance.
Health insurance programs differ significantly in how they reimburse providers. Employer-sponsored plans and government programs pay at different levels, with government programs typically paying below the cost of care. In West Virginia, this challenge is even more pronounced. Nearly 80 % of hospital patients are covered by governmental payers, compared to a national average of about 40 %. Because these programs do not cover the cost of care, employer-sponsored insurance must pay more to offset the shortfall and effectively subsidize government programs.
It’ s important to recognize that having coverage is not the same as using services, which is referred to as utilization. Government programs predominantly serve seniors, individuals with chronic illnesses and people with disabilities. Consequently, these beneficiaries access services more frequently than the generally healthier working-age adults
West Virginia Hospital Revenue by Payer Source
West Virginia Health Insurance Plans by Covered Lives
|
Medicaid |
|
The Health Plan |
Medicare |
Non Govt.
PEIA & Other Govt.
|
Highmark West Virginia |
Aetna Life United Healthcare Cigna Health CareSource |
|
|
|
Other |
Source: WV Health Care Authority 2023 Uniform Financial Reports
Source: WV Office of the Insurance Commissioner 2023
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