Further, as HMOs compete with each other to acquire and preserve market share, they have continued to ratchet down rates to providers. The continued pressure to produce savings has restricted access to services for many consumers and eroded the ability of hospitals and health systems to provide care to Pennsylvania's uninsured citizens. The growth of uninsured Pennsylvania residents is among the fastest in the nation. By virtue of their location, many institutions that serve a disproportionate share of the uninsured are in crisis. In those cases, the safety net for the poor and uninsured is in danger of being shredded.
Medical technology continues to advance at a geometric rate.
Outpatient visits have increased 16.6 percent statewide from 1995 to 1997. This reduces the need for inpatient services, capacity and employees. Hospitals now have to deal with the debt they took on when government policy encouraged them to compete in a free-market environment by expanding their ability to deliver a full spectrum of services. New and expensive technology, public demand for more affordable health care, lower government payments, increased use of managed care, and competition have all contributed to a changing health care delivery system. Every hospital in Pennsylvania must adapt to these important changes.