THE MANY shortcomings of the District's public health system are well known. Far less attention has been paid to the city's suburban counterparts, where poor people have even fewer options and face longer delays in receiving primary and prenatal care. The regional picture shows that the current public/private health care mix is ill-equipped to deal with the needs of the poor.
In Montgomery County, for example, public health clinics do not offer routine care for female patients. A poor pregnant woman in Prince George's County has an eight- to 10-week wait for an initial prenatal care appointment at a public health clinic. In Alexandria's public health system, the waiting period for prenatal care is as long as nine weeks and longer for other kinds of routine care.
If a local Maryland woman has Medicaid and needs a private gynecologist or obstetrician, she is out of luck. Of the more than 120 private gynecologists and obstetricians in Montgomery County, not one is accepting new Medicaid patients. Only three of 23 such doctors in Prince George's County take Medicaid recipients. Why? Too much cumbersome paperwork, too many delays in receiving Medicaid reimbursements, and the reimbursements are so low that they don't cover their share of the physician's malpractice liability insurance costs. For some of the same reasons, private physicians have been slow to volunteer for the new Maryland Access to Care program, designed to pair Medicaid patients with doctors.
There are some alternatives. Both Virginia and the District have limited versions of so-called Good Samaritan laws. In the District, doctors who stop to help accident victims are immunized from civil suits except in cases of gross negligence. The same is true for Virginia doctors who perform volunteer work at free clinics. Both efforts could be expanded to cover doctors and specialists who are generous enough to offer free care in Virginia's state health clinic system and in the District's public health clinics.
In Maryland, doctors who participate in the Access to Care program are offered a higher than normal Medicaid reimbursement, but one that perhaps is not quite high enough to attract more physicians. A somewhat higher reimbursement should be considered, since the state could save money if got more Medicaid recipients into cheaper primary and preventive care. It would be less expensive than a significant expansion in local and state public health clinic services and far preferable, medically and morally, than a system in which medical care is too often delayed or denied.