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nytATLANTA — Pamela Vaughn is a Grady baby. Ms. Vaughn was not only born at Grady, she also works there, as a senior nurse in the diabetes clinic, where many of her patients are Grady babies, too. And now, like thousands of other Atlantans, she is hoping to save the teeming charity hospital that has provided her with both life and livelihood.
To generations of Georgians, this city is unimaginable without Grady. Yet that has been the prospect facing the region for the last year, the result of a multimillion-dollar shortfall in the cost of providing charity and emergency care that no one — not the counties, the state nor the federal government — has been willing to cover, though Grady provides vital services to the entire region.
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Although the hospital is unique in many ways, the code red at Grady is emblematic of the crippling effect America’s health care crisis has had on public hospitals around the nation. Though Grady is among the most distressed of the country’s 1,300 public hospitals, others have faced similar challenges in recent years, including those in Miami, Memphis and Chicago, said Larry S. Gage, president of the National Association of Public Hospitals and Health Systems. There are 300 fewer public hospitals today than 15 years ago, with hospitals having closed in Los Angeles, Washington, St. Louis and Milwaukee, Mr. Gage said.
Dr. Carlos Del Rio, Grady’s chief of medicine, calls the hospital “the canary in the coal mine.”
Like other public hospitals, Grady is operating on a business model that is no longer sustainable. A third of the hospital’s patients, including those treated as outpatients, are uninsured, among them a rapidly growing group of immigrants. Another third are covered by Medicaid, which reimburses at rates well below Grady’s actual costs. Many hospitals use their privately insured patients to subsidize indigent care, but at Grady, only 8 percent of inpatients fit the privately insured category.
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http://www.nytimes.com/2008/01/08/us/08grady.html?hp