MANY STATES now face a problem that has no easy solution -- the high cost of providing medical care for Medicaid recipients and for those who have no health insurance. Virginia is one of several states facing lawsuits brought by hospitals that are seeking higher Medicaid reimbursements. In several cities, hospitals that have provided large amounts of uncompensated care are finding they can no longer cope with the costs. Now, Maryland health officials are hoping to avoid such problems through a system of "managed" health care that targets two crucial flaws in health care for the poor.
Nelson Sabatini, deputy director of Maryland's health department, says the new program is designed to reduce the burdens on hospitals by spreading responsibility to private physicians, community health clinics, health maintenance organizations and hospital outpatient clinics. It would also reduce costs by trying to shift from expensive acute medical care to less costly regular and preventive care.
Under the plan, two-thirds of the state's 343,000 Medicaid recipients will have the chance to choose a physician who accepts Medicaid recipients, or they can be assigned to a doctor, health clinic, HMO or other facility. Those doctors or clinics will stress regular health care and decide when the patient truly needs the services of a hospital emergency room. A key ingredient here will be the participation of other health care providers. To encourage private physicians, the state plans to double the reimbursement doctors receive when they take in Medicaid patients.
This new program is important for several reasons. Too often, poor people avoid regular care. Their first brush with medicine is a visit to a hospital emergency room, since they have waited until their illness has become so acute that it require extensive and costly treatment. In many cases, those illnesses are either preventable or manageable through regular care. The other problem is that many of the poor are simply not connected -- to a physician or even to a public health clinic -- and so they again wind up in hospital emergency rooms for ailments, injuries or illnesses that really do not require emergency care.
The Maryland effort represents a step in the right direction. This is a path that could lead to better health for the poor and, ultimately, to a less costly system of medical care.