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Concerned over proposed drastic fee increases at LBJ

By Fili Sagapolutele PAGO PAGO, American Samoa (The Samoa News, Dec. 13, 2011) – Gov. Togiola Tulafono and Fono leaders will meet again this week to discuss ways to financially assist the Lyndon B. Johnson (LBJ) Medical Center, who plan to hike facility fees by up to 400% on Christmas Eve, and the proposed rates are the subject of two House hearings this week.

The first meeting was held last week following a letter from the governor to Senate President Gaoteote Palaie Tofau and House Vice Speaker Talia Fa'afetai Iaulualo about the rate hikes and requested a meeting to examine what the hospital is proposing and determine how the government can best respond and assist the hospital.

"While I can appreciate the need of the authority to survive and continue to provide essential critical services to our people, I am afraid that the degree of increases may discourage many of our residents from seeking medical attention at the medical center," the governor wrote in a Dec. 5 letter to the Fono leaders, adding that the hospital is proposing "very drastic increases."

"I am prepared to support some level of reasonable increase but it may require that we, as a government, also contribute financial assistant to keep the cost to our people at [a] reasonable level," he said.

On his weekend radio program, the governor asked the public to be patient at this point while he and the Fono leaders work on ideas and solutions to financially assist LBJ. He says that following a meeting last week, the Fono leaders are now working on ideas and solutions with both sides to meet again this week.

As to critics of the proposed fee hikes, Togiola said the hospital cannot be fully operational unless they come up with sufficient funding. He said the hospital has a plan in place for low-income families as well as all patients with varying income status.

He acknowledged that the proposed rates are a drastic hike when compared to the local economic conditions, which is something that needs to be taken into consideration.

A caller to the program outlined her research into the cost of hospital services off-island, which are much higher than what LBJ is proposing and she also noted that there is also insurance to help pay for the costs at the hospital.

[PIR editor’s note: In accordance with new expectations of patients to pay for care, some hospital clients at LBJ who require off-island care will be paying for their own services. LBJ administration says that, because of financial restrictions, no funding was allocated for the current fiscal year towards off-island treatment, although the hospital provides referrals. Estimates for a fully-functional program are close to US$6 million yearly.]

Togiola thanked the caller for the information and noted that "I always believe that we need to pay our way. But there is also – as I am very much aware – limitation" because not everybody in the community has the same ability to pay high fees.

"For us here, unfortunately, this is the only facility we can go to, so we all have to end up at LBJ. So we have to support our hospital, we have to support their work, but we also realize they cannot operate without [necessary] funds," the governor said.

"So it's reasonable to expect that we will have pay some of the services, but we also must expect that the rates have to be compatible with economic conditions in the territory," he said, adding that whatever the administration and the Fono comes up with, they will be rates and rules and policies that are consistent with life in American Samoa.

He said there is a good portion of the population that will require some attention "and it is our duty – if we are doing [financially] well – all of us who make more money, have an obligation to look after the unfortunate ones in our community."

He said medical services are not free and there has to be portion for the public to pay. He said the last solution is to hike taxes, but that will fall right back to the public.

According to the governor, the administration and the Fono are working on ideas and recommendations to ensure that no lives in the territory are affected due to the proposed rate hike.

LBJ's rates are the subject of two House hearings this week with the first one set at 9a.m. today for the House Health/LBJ Committee and witnesses being called to testify are LBJ'S chief executive officer, Mike Gerstenberger and the chief financial officer, Viola Babcock.

Tomorrow at 9 a.m. is the House Budget and Appropriations Committee hearing and witnesses to testify are ASG Treasurer Magalei Logovi'i and Budget and Planning Office director Malemo Tausaga.

Meanwhile, the local non-profit group Pualele Foundation and its community partners are holding an "Open Forum Rally" at the Fagatogo Malae on Dec. 22 regarding the fee hikes.

"Come and express your concerns toward the rising ‘Health Cost' at LBJ. It's an issue close to our hearts' health," according to a news release from group, which was established in 2005 to provide services to the community in stress management and crisis counseling.

"The health cost open forum rally is for our citizens to express positive suggestions in lending a helping hand to our local hospital, lawmakers and the present administration in assisting the... community into a new year of hope, goodwill and a balanced cost of health care for all," the foundation says.


In its press release announcing the hospital fee hikes early this month, LBJ noted that "the expenses for the Hospital are regular and predictable. We cannot guarantee the availability of patient services without a regular and predictable revenue stream."

LBJ will work with Gov. Togiola Tulafono and the Fono to "identify sustainable sources of income to assure that LBJ will be here when you need us," the statement said.

"However it is clear from government at all levels that a component of that sustainability needs to be a greater personal responsibility for patients to fund their own medical care," it said.

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