In Maryland, a prescription for better health care

January 17, 2012

Maryland is near the top of the national rankings in median household income, but the state’s great wealth does not equal good health for everyone.

Instead, the state has troubling clusters of chronic disease, low-birth-weight babies and limited access to health care for those who lack the means to pay. Areas with large minority populations, including Prince George’s County, are especially hard-hit.

A proposal unveiled Tuesday by Lt. Gov. Anthony G. Brown (D) aims to narrow the gap between Maryland and other states that, for a variety of reasons, have healthier communities and easier access to good medical care, especially primary care.

Brown, a former legislator from Prince George’s, has long pushed to expand health care in underserved communities.

The proposal, which was devised by a group led by University of Maryland medical school Dean E. Albert Reece, urges lawmakers to create health-care zones, which would mimic economic-enterprise zones that have been in use, with varying degrees of success, for several decades. The idea is to have local and state governments use their taxing authority to offer incentives to lure doctors, physicians’ assistants, nurses and other medical professionals to set up practice in underserved areas.

The proposal also establishes a cash prize — the amount is to be determined — for communities or nonprofits that find innovative ways to improve the overall health of a community. And it proposes incentives for hospitals to measure success rates by race and ethnicity, in addition to traditional methods, such as lower re-admissions.

“There is, I think, both a moral imperative and, quite frankly, an economic imperative and a case to be made that health disparities need to be eliminated,” Brown said in an interview in advance of the announcement.

Improving residents’ health can cut public spending on health care and reduce the state contribution to Medicaid, the health-insurance program for low-income and disabled residents.

Experts studying health-care delivery in 2009 estimated that the nation could save $230 billion in direct medical expenses if racial and socioeconomic disparities were eliminated.

In the Washington area, the disparities are evident in Prince George’s County, which has a large minority population; high rates of asthma, HIV infection and diabetes; a limited number of primary-care medical practices; and many residents who lack health insurance.

A 2007 Rand report, commissioned by the Prince George’s County Council, found that an estimated 80,000 adults in the county are uninsured, more than twice as many as in Howard County, and about one-third more than in Montgomery County. Prince George’s also has fewer primary-care physicians per capita when compared with its neighbors, and few primary-care physicians in practices in poorer neighborhoods.

Other data show that blacks in Maryland are nearly twice as likely be hospitalized for such treatable conditions as asthma, hypertension and heart failure, costing Medicaid an additional $26 million.

Residents lacking access to health care often wait until they are so sick that they can get admitted to the emergency room. That increases the cost of treatment and in many instances, “you are getting poor results,” said Joshua Sharfstein, Maryland’s health secretary. But if there are more primary-care providers, the underserved communities such as those in Prince George’s could become healthier at a lower cost because treatment is provided in less-expensive, outpatient settings, he said.

Brown said he hopes that a pilot program could be set up this fall. He said it would encompass one urban community and one rural community. The governor’s budget, to be released Wednesday, is expected to include funds for the pilot program, Brown said.

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