How to Solve the Hospital Crisis

Greater Southeast Community Hospital and Prince George's Hospital Center teeter on the edge of closure -- a race to oblivion east of the Anacostia. These facilities serve a population with demonstrably poor health, including high rates of infant mortality, obesity and diabetes as well as violent crime.

Should either fail, the resulting shift of patients would probably doom the other. There appears to be little coordination between the two systems -- and their would-be rescuers -- because one lies in the District and the other in Maryland. But the terrain, population and problems are virtually identical on both sides of the border.

Both the District and Maryland are led by young, energetic, urban Democrats who have been in office for less than a year and who are committed to improving life for the disenfranchised. The time is right for a health improvement initiative that involves both jurisdictions.

Successful examples of multi-jurisdictional management and delivery of critical services abound: parks, airports, mass transit, water and sewage. Economic revitalization has been sparked by business improvement districts.

Such an approach should be considered for the health of these regions. A semi-autonomous operating entity, an Anacostia health improvement district and authority (a jointly governed public benefit corporation), could create a unique and innovative public health intervention. This would build the foundation for several coordinated actions:

· Objective and independent evaluation of the needs of the community and the ability of the surrounding area to address those needs. This is critical, both for the baseline that it would establish and because the process is fraught with social, political and economic minefields.

· The purchase of the two facilities. While this may lead to the temptation to politicize their administration, the intersection of for-profit health care and a population that relies heavily on public assistance has proven untenable.

· Luring talent to create and lead this innovative approach, compensated at a level that would retain that talent.

· Affiliation with one or more academic medical systems, bringing additional medical talent and specialty care capabilities.

· Enhancing reimbursement for the treatment of medical conditions prevalent in this region.

· Pursuing grants designed to alleviate morbidity and mortality in targeted ways. This should be done through a combination of government and private foundation funding sources.

· Integrating associated services -- school health, dental, immunization, health promotion and education -- into the fabric of the community. This calls for links to community services organizations and coordination with churches and other outlets that could host initiatives to integrate health care into the community, such as parish nurse programs.