If you believe economic hardship affects only the neediest layers of a community, there’s a lesson to be learned in the plight facing Spokane’s hospitals.

Empire Health Services, which operates Deaconess Medical Center and Valley Hospital and Medical Center, is in the process of layoffs and reduced hours that will affect 150 positions at the two facilities. Empire says it needs to cut staff by 8.6 percent in response to operating losses that are running about $1.5 million a month. News of Empire’s reductions was followed this week by a similar announcement that Sacred Heart Medical Center, Holy Family Hospital and other elements of Providence Health Care will be announcing layoffs of their own this month.

Various reasons contribute to the problems, but a major issue for both Providence and Empire is directly related to adverse economic conditions. The amount of care hospitals are providing without compensation – due to indigency, lack of insurance and pure bad debt – is soaring. At Sacred Heart, for example, uncompensated care has doubled since last year. That facility isn’t losing money yet, but it will be if that trend continues.

Hospitals across the nation are experiencing similar difficulties, but with high levels of poverty and unemployment, this community can’t afford more layoffs. The health-care industry, after all, is supposed to provide a stabilizing link between nursing education, medical research and economic development. Such a strategy is a key to job creation that would help reverse the trends causing the hospitals and other businesses in the area – not to mention so many needy families and individuals – serious difficulties.

In the meantime, local medical centers’ problems are aggravated by a reimbursement rate that puts them at a disadvantage compared with their counterparts on the west side of the state. Medicaid and Medicare payments that cover treatment given to low-income and senior patients are made at a lower rate at Sacred Heart and Deaconess than at institutions in Seattle.

State officials say Medicaid reimbursement is based on actual costs, which are higher in Seattle, partly because of differentials in the two areas’ economies, partly because of different roles played by the facilities. The University of Washington’s Medical Center, for instance, has significantly higher teaching activity than other hospitals in the state. Harborview is a regional trauma center, necessitating costlier equipment.

Spokane hospital officials say the differentials aren’t enough to justify the 25 percent reduction in reimbursement between UW and the Spokane hospitals. Moreover, the formula makes no note of efficiency standards, so as the Providence and Empire operations find more streamlined ways to provide quality care while tightening their belts, it could just make matters worse for them down the road.

The Medicaid and Medicare reimbursement rates are matters of government policy that determine how tax dollars are apportioned. Spokane’s legislative and congressional representatives have a critical role to play in assuring fairness. It needs to be a high priority for them.