Prince George’s County survey intended to gauge state of health care

February 15, 2012

The questions are simple: Where do you go to the doctor? How long does it take you to get there? If there were a new hospital closer to home, would you use it?

But the survey underway in Prince George’s County is intended to address a complex problem. Officials expect the data to give them a detailed look at the state of health and health care in the county, where conditions such as diabetes and heart disease are much more common than in the rest of the region and most of the state.

At the same time, officials hope that the information will help determine how to build a new regional hospital and primary-care network that would attract residents from a broad range of incomes and ethnic backgrounds.

Local government and health officials are looking not only at how much a hospital would cost to build but also at what types of services residents need to help them stay healthy and out of the emergency room.

“The basic question they are asking is what would a hospital center and a network around it really mean for health in the county,” said Joshua Sharfstein, Maryland’s health secretary. “It’s not just the number of visits and services; it is about how to design a system to maximize the effect on health.”


That approach, planners hope, could help lower high rates of asthma, diabetes, HIV, heart disease and low infant birth weight in the predominantly black county — problems that have been linked to racial disparities in health care.

At the same time, it could help the system become financially secure by attracting patients from inside and outside the county who can afford to pay for care.

“In Prince George’s County, you have an interesting dynamic,” said Stephen B. Thomas, director of the University of Maryland Center for Health Equity. “You have the highest-per-capita-income black population in the United States. Some of the premier health institutions in the country are in our state. The National Institutes of Health is in our back yard. Yet you have among the biggest health disparities in our country. Why are we not translating what we know?”

The center is part of the university’s School of Public Health, which is conducting the community survey and expects to assess the views and needs of 1,000 residents.

Last year, after several years of political wrangling, state and county officials, prodded by Prince George’s County Executive Rushern L. Baker III (D), announced a $600 million plan to build a new regional hospital in Prince George’s to replace the ailing Prince George’s Hospital Center.

Large indigent population

The publicly owned hospital, which is operated by Dimensions Healthcare System, serves a large number of indigent patients and relies on $30 million a year in subsidies from state and county funds.

Those expenditures have done little to improve the county’s troubling health statistics. And with pressure intensifying from the federal government to rein in health-care costs and improve public health, officials knew further delay could impair the state health-care system’s ability to continue to qualify for key federal financial support.

The signers of the 2011 agreement — the county, the state, the University of Maryland Medical System and Dimensions — agreed not only to build a new hospital but also to create a robust network of primary care providers, who are in short supply in Prince George’s. The plan is for the new hospital and the affiliated health-care providers to serve residents of all income levels and offer a range of services that would be attractive to patients who can afford to pay, as well as those who cannot.

Building a hospital from scratch is uncommon because of the huge expense. But Jill Horwitz, a professor of law and health policy at the University of Michigan, said the prospect that the proposed health-care system in Prince George’s would be designed to have broad appeal, as well as the expectation that the federal Affordable Care Act will expand health insurance, could create a viable financial model.

An affiliation with a university adds to the allure, she said.

“This could work. . . . Typically, university systems are pretty high-quality and they do attract a lot of patients, and are able to do more sophisticated treatments.”

If the plan for Prince George’s succeeds, officials think it could reduce the need for a continuing public subsidy and, at the same time, improve residents’ health. Plans call for the hospital to be built by 2017; the health network could be established sooner.

A 2009 Rand study suggested that there is much work to be done to improve the health of Prince George’s residents and the financial underpinnings of the county’s health-care system.

The study estimated that as many as 150,000 residents lack health insurance or have insufficient coverage. It found that county residents are more likely to use emergency rooms than are residents of neighboring communities; medical practices are not spread throughout the county, making access difficult for some residents; and pediatric practices are clustered in the county’s most affluent areas.

The county also needs more primary-care medical practices for its nearly 900,000 residents, according to the study. And, many county residents seek health care elsewhere, because of convenience — 60 percent of county adults commute outside Prince George’s — or because residents cannot find what they are looking for inside the county.

That has done more than affect the quality of health care, the study said. It also has been a financial drain on the county that has led to “ lost revenue to county hospitals, lost revenue to local businesses serving them, and lost jobs for county residents.”

To better understand all the reasons for residents’ health-care decisions, surveyors are asking residents to explain where they go for health care, whether they use public transportation or drive and how close they live to parks and grocery stores. The survey will collect information about how long it takes residents to get to work, what they eat and how they perceive medical care in Prince George’s.

“Bringing in community residents’ perspective is rarely done at this stage of planning,” said Sandra Crouse Quinn, the health equity center’s senior associate director.

Center officials declined to provide a copy of the survey, saying that to do so could bias the results. They described it in general terms. Accounting firm KPMG is conducting a separate financial analysis.

What patients say

Those who use health-care providers in the county report mixed experiences.

“Physicians here work hard. Their offices are swelling to the brim with patients,” said Christian Harriott, a Bowie resident and pharmaceutical representative who sees the crowding when he makes his rounds of his doctor clients.

Tia, a Bowie mother of four who declined to give her last name in order to protect her family’s privacy, said she relies on Medicaid for health insurance. She is unemployed but hopes to find work that would provide health insurance, she said as she picked up a food donation at Gethsemane United Methodist Church in Capitol Heights.

Tia has used Prince George’s Hospital Center but envies her sister, who has private health insurance and goes to the more highly regarded Holy Cross Hospital in Montgomery County. Although Tia was fortunate to find a doctor in Largo, she said, the waits are long, and she’s not sure it’s the right practice for her teenage daughters.

“Some doctors don’t take Medicaid,” she said, explaining her reluctance to switch practices.

Cinthia Rivera, who sought treatment for depression last year when she was 19, has found it difficult to obtain. She was no longer covered by her mother’s health insurance and had none of her own. She was able to go to a counselor at the Maryland Multicultural Youth Center in Langley Park for a few months because of her job there, but she reached the limit on the number of visits.

“I would like to go back to a counselor,” Rivera said.

The survey’s results and KPMG analysis are expected in March.

Thomas, of the University of Maryland’s health equity center, said the prospect of building a health-care system, rather than a “sickness system,” is exciting.

“It can be focused on promoting health and preventing diseases,” he said.

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