The District's health care system for the uninsured is undergoing a revolution, but you wouldn't know it from reading the newspaper or listening to politicians, whose speeches are all about financial problems at Greater Southeast Community Hospital and the sniping between the mayor and some D.C. Council members about D.C. General. But we now have the first-year figures for the Alliance, Washington's new health program for the uninsured, and they are dramatic.
Compare the services provided by the Alliance during the past 18 months with those provided by the Public Benefit Corp. a year earlier: Monthly emergency room visits dropped from 2,797 to 1,202 in the first year of the Alliance. By contrast, monthly outpatient and clinic visits rose from 5,917 to 6,224 in the first year and to 10,945 in the current year.
These figures represent progress.
Emergency room care is provided under crisis conditions by doctors who have no experience with the patient involved. Sometimes the care comes too late. The focus of health reform is to hook up families with health providers before problems become emergencies, so that prevention and continuity of care can be emphasized. That's what seems to be happening under the Alliance.
The Alliance has its critics, of course. With the closure of D.C. General's inpatient unit, some people argue that emergency room visits are being shifted to the private sector. To a point, they're probably right. Emergency room visits at private hospitals have increased significantly during the past year, but they also have done so throughout the nation. How much of this is due to the Alliance is unknown, but the District should find out and pay the associated costs. Mayor Anthony Williams said as much at a health summit last month. The intent of health reform was never to shift the District's burden for uncompensated care to private providers.
But let's not lose sight of the important point, which is that Washington's health care system is moving in the right direction. In the past, it has been too emergency-room-based, and almost all health care dollars went into treating people after they got sick instead of into preventive care. Now we are paying more for prevention and less for emergency care. Specialty referrals once took as long as a year, says George Jones, head of the Bread for the City Clinic; that wait is now two to six weeks.
This is a real improvement. And the new system is costing at least $30 million a year less than the old one -- that's the difference between what the District paid the Public Benefit Corp. in fiscal 2000 and what it spent last year under the Alliance. So while charges fly among the city's political leaders, let's not overlook the progress we're making under the new system. Problems -- and plenty of complaints -- remain, but it's a big step forward nonetheless.
-- Paul Offner
-- Gloria Wilderbrathwaite
are members of the
Mayor's Health Reform Commission.