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Tips and Guide to the Top Health Care Employers:

About this book

Get the inside scoop on the most important health care employers, with company overviews, recent company news, info on the hiring process, and more. This new Vault guide features the top employers in the industry, including Medtronic, Baxter Healthcare, HCA, Inc., and Tenet Healthcare Corporation.

Read an excerpt from the Vault Guide to the Top Health Care Employers

An Industry in Flux
You can't live with it, you can't live without it this pretty much sums up the attitude many Americans have toward today's health care industry. The industry is made up of a variety of providers of patient care, including hospitals, nursing homes and physicians' offices, as well as those who help coordinate, manage and pay for that care, like HMOs and other health insurers. It's no secret that the sector is a volatile one. Despite making up nearly 15 percent of the nation's gross domestic product (GDP) , U.S. health care spending totaled $1.8 trillion in 2004 the industry has had a tough time figuring out how to turn healthy profits in a way that benefits both providers and patients. The growth rate in the industry has consistently outpaced the growth rate of the overall economy in recent years. Economists predict health spending will make up 18.7 percent of the country's GDP in 2014, a percentage considered "unsustainable" by many analysts. In fact, it is estimated that the public sector will pay for nearly half of all health spending in the U.S. by 2014.

Having a Senior Moment

By the year 2050, seniors will outnumber children for the first time ever, according to the AARP. With approximately one million people turning age 60 each month worldwide, the phenomenon known as "global aging" promises to have a deep impact on the demand for and delivery of health care services. In the U.S., the Baby Boom generation those born shortly after World War II up to the mid-1960s makes up a sizable portion of the total population. In fact, people aged 50 and older are the fastest-growing demographic group in the nation. This shift is already sparking interest in all issues affecting senior health from preventive health care to ward off problems later in life, to programs promoting home care and assisted living as alternatives to the dreaded nursing home option for seniors who can't take care of themselves.

Creaky Medicare

With an aging population comes growing pressure on the nation's reimbursement system for seniors and low-income patients. In the U.S., the federal government looms large in health care -- though not as large as some patient advocates would prefer (we'll get to health care reform later). In fact, ranked by sales, the government's own Centers for Medicare & Medicaid Services (CMS, formerly known as the Health Care Financing Administration) ranks No. 1 in the industry, according to data from Hoovers.com. Around 40 million Americans are eligible for Medicare coverage, more than twice as many as when the program was first established in 1966 under President Lyndon Johnson. In 2002, Medicare spending made up about 17 percent of total health care expenditures, or $267 billion, roughly equal to the 16 percent coming from Medicaid (which is administered by the states and covers low-income patients as well as senior citizens). From 2003 to 2004, Medicare expenditures increased 15.2 percent, nearly twice as high as the largest growth percentage in recent years. The Centers for Medicare and Medicaid Services estimate premiums for enrollees will rise to $89.20 per month in 2006, roughly $1.50 more than Medicare trustees projected. Medicare claims are submitted by health care providers through intermediaries or carriers, entities that have contracted through the government to serve as middlemen in the payment process. After navigating a tricky labyrinth of rules regarding coverage, these claims are either accepted or denied by the contractors. Top Medicare contractors include BlueCross BlueShield organizations in a number of states, plus other companies such as Palmetto GBA and Empire Medicare Services.

The Medicare program, perennially the subject of reform packages in Congress, is a political hot potato. Under the Bush Administration, a heated battle was waged between patient advocates and lobbyists for insurers and pharmaceutical companies in an effort to get prescription drug costs under control. In 2003 the administration established a prescription drug discount card for Medicare beneficiaries, but critics argued that it wasn't the solid overhaul the program truly requires. Bush's plans in his second term for Medicaid have also come under fire. Among his administration's proposed changes are reducing the federal matching rate for targeted case management (which often funds mental health services and assertive community treatment), reducing pharmacist reimbursement rates for prescription medications provided to Medicaid beneficiaries and capping the federal funding match for state administrative services costs, including outreach, enrollment and quality assurance. Also in the works is a proposal to fix faulty pricing techniques, which have caused Medicaid to overpay for some of the drugs it bought in the past, according to a March 2005 report by the Government Accountability office.

Flying Without a Net

The rest of the population -- those who aren't eligible for Medicare or Medicaid coverage -- either have to buy private insurance on their own, get it at discounted rates through an employer, or just go without and hope for the best. An alarming number of Americans, including many children, are in the latter category. In early 2004, almost 44 million Americans (about 15 percent of the population) were uninsured. Additionally, an April 2005 report by the Health Affairs Policy Journal predicted that the number of non-elderly uninsured Americans will grow to 56 million by 2013. Not only do these people risk financial meltdown when faced with unexpected medical emergencies, they're also less likely to rely on routine visits to doctors, dentists, and the like to maintain good health and prevent the onset of more serious conditions down the line. In addition, reports indicate that health care is more expensive overall for the uninsured. For example, some hospitals bill uninsured clients a higher rate for the same procedures provided to those with health coverage, since big insurance companies are able to negotiate discounts with providers.

The situation isn't so rosy for consumers fortunate enough to have coverage, either. Private health insurance companies paid for 35 percent of the total health expenditures in the U.S. in 2002, nearly $550 billion. But as the cost of providing health care coverage continues to rise, many employers are finding they can no longer afford this benefit, and are passing more of the costs on to employees in the form of higher premiums and stingier reimbursement plans. The American Medical Association is currently at work to put together a plan that mixes private and public sector financing to benefit the uninsured and improve quality of care and patient choice, with features like tax credits for the purchase of insurance and a wide range of affordable insurance options.

Unmanageable Care

Managed care, which came into prominence in the 1980s and 1990s as a response to rampant inflation in health care costs, has changed the face of the industry. Under these systems, insurers (also known as "payors") figured out that they could rein in costs by establishing networks of providers who participate in a network or health maintenance organization (HMO), which in turn covers a host of covered patients' needs. But in order for the reimbursement to be profitable, healthcare providers have to curb their own costs. This includes keeping strict limits on the amount of time they spend with patients to maximize the number of appointments they can squeeze in during a day leading to the hour-in-the-waiting-room, five-minutes-in-the-exam-room doctor visits many Americans experience today. Top managed care corporations include Anthem, HealthNet and UnitedHealth Group.

As illustrated by Hollywood dramas, prime time news programs and even the Gore presidential campaign, the public largely sees HMOs as stingy and heartless, willing to deny society's neediest members basic procedures that are deemed too costly or unnecessary through an impenetrable system of rules and limits. For their part, managed care organizations argue that without these limits, the cost of health care would rise for everyone in the network (and society at large), nullifying the benefits of such a system. Meanwhile, the government has gotten into the managed care game, allowing patients to participate in the "Medicare+Choice" program, which also operates under the provider network philosophy. As with much government-speak, the program actually controls costs by limiting patient choice, not adding to it, skeptics contend.

Where the Jobs Are

In spite of its daunting complexity, the health care industry has one big upside it's a reliable producer of job opportunities. The health services industry, the largest of all industries categorized by the Bureau of Labor Statistics (BLS) as of 2002, provided nearly 13 million jobs that year. Of the 20 occupations the BLS projects to grow the fastest in coming years, half are in the health services sector. And of new wage and salary jobs that will be created by 2012, about 16 percent will be in health services more than in any other industry. According to a February 2005 report by CNN/Money, many of the fastest growing employment opportunities are in health care. The Labor Department predicts more than 600,000 jobs in nursing will open up by 2012, while physician's assistant jobs will grow by 50 percent and occupational therapist jobs by 35 percent. Additionally, positions for home care workers will increase by 40 percent. Fitness trainers and dental hygienists are also expected to be popular professions. While the suggestion of working in the healthcare industry may conjure visions of crushing med school debt and grueling internships, in fact the majority of jobs in the sector require less than four years of college education. Graduates of one- and two-year certification programs might work as medical records and health information technicians. Service occupations abound, including medical and dental assistants, nursing and home health aides and facility cleaning jobs. The BLS predicts particularly strong growth in jobs outside the inpatient hospital sector, such as medical assistants and home health aides. There is a constant clamor for more nurses, as facilities face growing regulatory pressure to meet mandatory staffing levels.

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